Ghid/Protocol terapeutic in AVC 1
Ghid/Protocol terapeutic in AVC 1
Ghid/Protocol terapeutic in AVC 1
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<strong>AVC</strong> de emisfer<br />
- deficit motor/senzitiv<br />
- HHL<br />
- s<strong>in</strong>droame corticale<br />
<strong>AVC</strong> de trunchi cerebral/cerebelos<br />
- deficit motor<br />
- s. de nervi cranieni<br />
- s. senzitive<br />
- s. cerebelos<br />
+ coma<br />
<strong>Ghid</strong>/<strong>Protocol</strong> <strong>terapeutic</strong> <strong>in</strong> <strong>AVC</strong><br />
CLINIC<br />
<strong>AVC</strong> ISCHEMIC CONSTITUIT<br />
DIAGNOSTIC<br />
<strong>AVC</strong> LACUNAR<br />
- deficit pur motor/senzitiv<br />
- hemipareza ataxica<br />
- tulb. de vorbire<br />
LABORATOR<br />
URG = HLG completa,<br />
teste de <strong>in</strong>flamatie,<br />
coaculograma, glicemie,<br />
electroliti serici, biochimie<br />
hepatica si renala, profil lipidic,<br />
enzime cardiace<br />
E.K.G. cu 12 derivatii<br />
IMAGISTIC<br />
1<br />
CT. URG. RMN ANGIO<br />
CT/RMN<br />
ULTRASONOGRAFIE<br />
Eco. Doppler pe vasele cervico cerebrale<br />
Eco. Cord
Fereastra de timp potential < 3h<br />
(debut - ac <strong>in</strong> vena) => tromboliza i.v ( GOLDEN<br />
STANDARD) + TERAPEUTIC = tromboliza i.v. cu rTPA<br />
Doza: 0.9mg/kg/corp dar fara a depasi 90 mg total, d<strong>in</strong> care<br />
10% se adm. <strong>in</strong> ,,bolus'' i.v. <strong>in</strong> 1 m<strong>in</strong>. apoi <strong>in</strong> perfuzie<br />
cont<strong>in</strong>ua (<strong>in</strong>jectomat ) <strong>in</strong> prima ora.<br />
<strong>AVC</strong> ISCHEMIC CONSTITUIT<br />
TRATAMENT<br />
Fereastra de timp > 3h<br />
GENERAL:<br />
- -trat.HIP<br />
- -HTA<br />
- -febra<br />
- -H-E<br />
- -AB<br />
MEDICAL<br />
+<br />
TRATAMENT<br />
CI la fibr<strong>in</strong>oliza<br />
CHIRURGICAL<br />
ASA + CLOP. Ina<strong>in</strong>te si dupa<br />
tratament chirurgical<br />
- Angioplastie carotidiana + stent<br />
- Endarterectomie<br />
- Angiplastie carotidiana translum<strong>in</strong>ala<br />
percutana(PATCH) si/sau stent<br />
SPECIFIC <strong>AVC</strong><br />
- antiagregant plachetar <strong>in</strong> 48 h de la debut:aspir<strong>in</strong>a i.v,apoi ASAclop<br />
- anticoagulant-ACO:AIT recurent(embolie cardiaca disectie<br />
arteriala acuta,ocluzie acuta de vas mare,stenoza severa de<br />
carotida,tromboza venoasa cerebrala)<br />
2
Costuri:<br />
• 7-8 zile spitalizare costuri hoteliere<br />
• Imagistica<br />
• Laborator<br />
• Tratament profilactic al TEP (5-7 zile)<br />
• Tratament antialgic<br />
Anexa<br />
3
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