clinical practice guidelines for hemorrhagic stroke · hemorrhagic stroke ผศ.นพ. ......
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Clinical Practice Guidelines Clinical Practice Guidelines
forfor
Hemorrhagic StrokeHemorrhagic Strokeผศ.นพ.ไชยวิทย ธนไพศาล
ภาควิชาศัลยศาสตร คณะแพทยศาสตร
มหาวิทยาลัยขอนแกน
Definition of StrokeDefinition of Stroke
• rapidly developed clinical signsof focal (global) disturbance ofcerebral function lasting morethan 24 hours or leading todeath, with no apparent causeother than a vascular origin.
SynonymsSynonyms
• CVD• CVA• Stroke• Brain Attack
ClassificationClassification• Ischemic Stroke
– Thrombosis– Embolism
• Hemorrhagic Stroke– Intracerebral Hemorrhage– Intraventricular Hemorrhage– Subarachnoid Hemorrhage
Definition of CPGDefinition of CPG
• Systemically developed statements to assist practitioner and patient decision about appropriate health care for specific clinical circumstances
Why CPG ?Why CPG ?
• Too many information• Medical practice variation• Rising of healthcare costs• More expensive technologies• Malpractice lawsuits
AIM of CPGAIM of CPG
• Reduce inappropriate medical care• Resource utilization• Improve outcomes• Improve education
Evidence based Expert opinion
Practice guideline
Multidisciplinary team
Care map
• แนวทางเวชปฏิบัต ิเปนเครือ่งมือสงเสริมสุขภาพของการบริการดานสุขภาพที่เหมาะสมกับทรพัยากรและเงื่อนไขสังคมไทย
• ขอแนะนาํตางๆในแนวเวชปฏิบัต ิไมใชขอบังคับของการปฏิบัต ิ
• ผูใชสามารถปฏิบัตแิตกตางไปจากขอแนะนาํได ในกรณีที่สถานการณแตกตางออกไปหรือมีเหตุผลที่สมควร โดยใชวิจารณญาณที่เปนทีย่อมรบัในสังคม
Strength ofStrength of RecommendationRecommendation
Supported by data from non-randomized cohort studies, case series, case report, expert opinion or consensus
C
Supported by data from RCT with high false-positive and high false negative errors
B
Supported by data from RCT with low false-positive and low false negative errors
ARecommendationGrade
IntracerebralIntracerebral HemorrhageHemorrhage– Clinical
• Sudden headache• Sudden neurological deficit• Nausea vomiting
– Etiology• Hypertension
– Basal ganglion– Thalamus– Cerebellum– Brain Stem
• Ruptured AVM• Tumor• Blood Dyscrasia
IntraventricularIntraventricular HemorrhageHemorrhage– Clinical
• Sudden severe headache• Neurological deficit not common• Stiff neck
– Etiology• Hypertension• Ruptured AVM• Parasite
SubarachnoidSubarachnoid HemorrhageHemorrhage
– Clinical• Sudden severe headache• Neurological deficit not common• Stiff neck
– Etiology• Ruptured Aneurysm
– Anterior communicating Artery– Posterior communicating Aneurysm
• Parasite
Early ManagementEarly Management
• Airway• Blood pressure• Oxygenation• Hyperventilation• Foley’s catheter• NG tube• Position : head up
InvestigationInvestigation
• CT Scan ( contrast ??? )• Cerebral angiogram• CT Angiogram• MRI• MRA
Specific treatmentSpecific treatment
• Medical treatment• Surgical treatment• Interventional Radiology• Radiation
– Whole brain– Radiosurgery
Diagnosis and Initial Management of Stroke
Classification by Location
Management of Lobar Hemorrhage
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