IV fluids for stroke pt's

[Lisa O]

lETAS LOOK AT THE PATHOPHSIOLOGY OF A CVA. YOU HAVE A THROMBUS, EMBOLUS, LUCANA, ANYERUSIM,PONTINE HEMMEROGAE IN ANY CASE THEY ARE ALL CLOSED HEAD INTERVENTIONS. I HAVE NEVER SEEN A PERSON WITH HPOTENSION GET A STROKE , MAYBE HYPOTHERMIA WITH A RECIRCULATION DISPBRITUTION BUT FOR ALL INTENTS AND IMPRESSIONS HER BP WNL WHICH BASICALLY RULES OUT LUCANA AND WITH HER EYES PERRLE R/O PONTINE AND DID YOU SEEK ANY ADDITIONAL HISTORY PERTINENT LIKE EAR INFECTIONS SINUS INFECTIONS OR ANY OTHER TYPE OF BRAIN DISORDER LOU GERIG, MYASTHINIA GRAVIS ETC. THIS WILL HELP YOU IN YOUR QUEST HER ECG WAS NSR AND NO POSSIBILITY OF STOKES ADAM. IT SEEMS LIKE A STOKES ADAM WITH A UNDERLYING POSS MI DIN'T SAY ANYTHING ABOUT DIABETES. GERIATRIC MEDICINCE IS A BRANCH ALL IN ITS OWN AND REPEAT EXPOSURE AND GOING OVER YOUR ALS REPORT WITH YOUR MD WILL HELP IN HONING YOUR SKILLS. a FLUID CHALLENGE TO R/O SOMETHING IS NOT PRUDENT IN THIS SITUATION.

CAPT MITCHELL STERN, AS, MPH, EMT-4, NCEMT-4 (RET)

I am trying to learn here, quit yelling.. lol

[tskstorm]

I see you don't need to know how to type, or spell to become a Capt!

Although the content of his post may be right that was some horrible formatting!

[Kiwiology]

I think Capt. Stern has a point, even if he does loudly communicate it

BTW WTF is an NCEMT and EMT 4

[treaux]

Unfortunately I can't get past the first word when it's in capslock.

[DwayneEMTP]

Holy shit...He only has two posts, took the time to get involved, and Really? The only thing the next page of posters could think to comment on is his caps lock and formatting?

C'mon folk. Some of us have done way more foolish things, I do them on a regular basis, perhaps we could show a new poster the courtesy of at least commenting on his content at the same time as bitching about his presentation??

Capt Stern, a few things, as I'm going to assume you might be new to forums. First and foremost, welcome to the City!! Thanks for taking the time to participate.

Presentation sucked..But that's not terminal, as I think your post content was really good! All caps is bad form. We're strong believers here, many of us anyway, that the way you present your ideas in text tells much about your intelligence and personality. Spelling, punctuation, capitalization, and paragraphs go a long way towards making your post easier to read and respond to. Also any 'lingo' that may be specific to your location, cert levels/radio codes, etc should be defined when used so that others are not confused by them. Not sniping brother, just trying to give you a heads up.

I absolutely agree that much more information was necessary, including your ideas on confirming that this was actually a CVA, is necessary before being able to determine whether or not fluid was appropriate. Though it's not uncommon here for folks to create a 'what if' scenario off of an actual call to help them ask a specidic question.

I found a lot of food for thought in your post, I'm grateful you took the time to create and it and had the courage to post it. I'm also confident given the information you need, if you haven't been discouraged by your first time out, that your presentation will be much different in the future.

And last, and possibly least, if most or all of that information came out of your head as opposed to being Googled, as I have a feeling it did, I have much to learn from you...I hope you'll stick around.

Have a great day all...

Dwayne

[aussiephil]

Holy shit...He only has two posts, took the time to get involved, and Really? The only thing the next page of posters could think to comment on is his caps lock and formatting?

C'mon folk. Some of us have done way more foolish things, I do them on a regular basis, perhaps we could show a new poster the courtesy of at least commenting on his content at the same time as bitching about his presentation??

Capt Stern, a few things, as I'm going to assume you might be new to forums. First and foremost, welcome to the City!! Thanks for taking the time to participate.

Presentation sucked..But that's not terminal, as I think your post content was really good! All caps is bad form. We're strong believers here, many of us anyway, that the way you present your ideas in text tells much about your intelligence and personality. Spelling, punctuation, capitalization, and paragraphs go a long way towards making your post easier to read and respond to. Also any 'lingo' that may be specific to your location, cert levels/radio codes, etc should be defined when used so that others are not confused by them. Not sniping brother, just trying to give you a heads up.

I absolutely agree that much more information was necessary, including your ideas on confirming that this was actually a CVA, is necessary before being able to determine whether or not fluid was appropriate. Though it's not uncommon here for folks to create a 'what if' scenario off of an actual call to help them ask a specidic question.

I found a lot of food for thought in your post, I'm grateful you took the time to create and it and had the courage to post it. I'm also confident given the information you need, if you haven't been discouraged by your first time out, that your presentation will be much different in the future.

And last, and possibly least, if most or all of that information came out of your head as opposed to being Googled, as I have a feeling it did, I have much to learn from you...I hope you'll stick around.

Have a great day all...

Dwayne

Well said Dwayne.

Dust, AK you may be able to help out here, I seem to recall something regarding the relationship to ICP & BP was not always a direct link & that even through a CVA the ICP could still be maintained, to a point, even if some fluid therapy was invoked. We need to remember here there is a huge difference between a haemhorragic & ischaemic CVA (althought this terminology is changing also. the medical fraternity is now saying it is not an 'accident' but an incident). With a haemhorragic CVA there is little hope of control & the patient has a very high mortality rate regardless of actions taken. Ischaemic CVA patients still have the ability to cope well & man can be suffering from dehydration if they have been 'on the floor' for any extended period.

Just a thought.....

[daedalus]

I have had the huge pleasure of attending a few lectures and watching some operative cases with a neuro-interventional surgeon who is using pioneering new procedures to remove clots with catheter based techniques while the patient is having an acute CVA. Smartest guy I know. Anyways, I routinely see him using Cardene (Ca channel blocker) to keep the pressures artificially low in stroke patients. He and his team are real advocates of head of the bed at 30 degrees and keeping the pressures low. No fluids unless otherwise indicated. Ill have to ask him about this.

[armymedic571]

Your best bet is to establish a line at KVO of an isotonic (non-dextrose ) containing solution assuming a normal blood sugar. While the concept of HHH therapy may apply in some cases, doing so in the pre-hospital environment is not a good idea. In fact, staying away from messing with blood pressure is a good idea. If hypotension or a fluid volume deficit exists, give fluids by all means, but overhydration with IV fluids and all that crazy stuff is not for the pre-hospital environment.

Do not get crazy with fluids guys unless you need to correct a deficit.

Take care,

chbare.

Tsk,

To add to what chbare was saying. Here is the basic concept: CPP (Cerebral Perfusing Pressure)=MAP (Mean Arterial Pressure)-ICP (Intercranial Pressure).

The basic theory behind the HHH therapy is to increase CPP to keep an appropraite level of perfusion going by increasing the MAP through IV therapy. This is important because in the case of a stroke it will help reduce the size of the penumbra. HOWEVER.....this is not something that should be attempted in the field. An ICP monitor needs to used, and we have to differentiate between a bleed or an occlusion before we start messing with the blood pressure. Not to mention other factors, like ( heart failure, Beta blocker use by the pt, etc).

Like I said, this a basic overview. There is a lot more to it, and to be honest. I don't think I fully understand it. So, I may not be the right person to try and explain it.

My system discussed this type of therapy in the past, and you can call Medical command with the request but, this is not something I would do lightly. Your exam needs to be extremely thorough, and depending on transport times and such you could be taking away from pt care trying to accomplish a full neuro exam.

Anyway, just a thought. This could have something to do with what you read.....Or I could be in left field. Which wouldn't be the first time.

[Mateo_1387]

I think Capt. Stern has a point, even if he does loudly communicate it

BTW WTF is an NCEMT and EMT 4

NCEMT may be North Carolina Emergency Medical Technician.

[1EMT-P]

I am not a big fan of starting saline locks only on CVA patients, especially if they are neurosurgical patients & going to be going to the OR. I can tell you from experience that during neurosurgical cases for cerebral aneurysms that they will sometimes induce moderate hypothermia by rapidly infusing IV fluids for cerebral protection.