Virtual Clinic v4
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No one can be sure specifically what causes TIA from CVA and vice versa... though in TIA, the chances of a thrombotic event is higher than a hemorrhagic one...Originally posted by ndmmxiaomayi:So which of the health risks will cause TIA or are all risks equal, meaning the patients will have an equal chance of developing TIA or cerebrovascular attack?
Why the sudden interest in CVA? -
...and your point being?Originally posted by thinkdifferent:That's it. Then on the other hand, it's different when you experience it as a patient. The things you have read and examined on others occur on yourself.
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So CT scan still necessary. Wonder who can find out whether which health risks will cause TIA or CVA and save the time for scanning. Patients will recover faster (or is it so?) without having to wait that half hour for the scan results.Originally posted by renorenal:No one can be sure specifically what causes TIA from CVA and vice versa... though in TIA, the chances of a thrombotic event is higher than a hemorrhagic one...
Why the sudden interest in CVA?
Not sudden interest in CVA. Since you got say about TIA and CVA, might as well ask. -
Time to log out. Will be back tomorrow morning to look at your answers.
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My point is, that some of my knowledge, especially in neurology is thanks to (or maybe I should say it's something for what I shouldn't be grateful as nobody would like to have it) things I have unluckily experienced on myself and have to live with them now.Originally posted by renorenal:...and your point being? -
wow.. havn't closed clinic ah..Originally posted by renorenal:...and your point being?
hee...
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Patients won't recover faster without having to wait half an hour for the scan results. The CT is important to find out what actually happened, how intense, in which part and so on. According to the CT results the doctors decide what to do.Originally posted by ndmmxiaomayi:So CT scan still necessary. Wonder who can find out whether which health risks will cause TIA or CVA and save the time for scanning. Patients will recover faster (or is it so?) without having to wait that half hour for the scan results.
Not sudden interest in CVA. Since you got say about TIA and CVA, might as well ask. -
A CT scan is mandatory rather than necessary according to the practice here. There is no confirm yes or no of isolated risks that can lead to TIA or CVA, as both event can occur. A TIA is partial obstruction while a CVA is total occlusion of the blood vessel. How that happens, partial or total is beyond a positive confirmation and prediction. Our best bet is through multiple papers of research and this will never also give a 100% effectiveness of what cause what, aside from being impractical.Originally posted by ndmmxiaomayi:So CT scan still necessary. Wonder who can find out whether which health risks will cause TIA or CVA and save the time for scanning. Patients will recover faster (or is it so?) without having to wait that half hour for the scan results.
Not sudden interest in CVA. Since you got say about TIA and CVA, might as well ask.
Stroke as I have explained earlier is progressive and changes occur slowly and over time in hours or days, which splits them up into categorization of TIA and CVA.
Recovering faster or not depends on the right treatment, though I may have to agree that 90% of the time you will be right if you treat the patient with an anticoagulant as you can be 90% sure that it is thrombotic in origin. However such issues lead to improper management and care of the patient.
You need to be in the situation to recognize and understand what actually happens during that time... a neurologist will tell you different things from what I tell you, and approach of practice of managing stroke patients vary widely.
During the first 30 minutes (some time can be as less than 15 minutes taking out the time of preparing the patient and setting up the equipment) the patient is actually being scanned rather than being left alone.
To sum up, a hemorrhagic stroke is usually more deadly and progress much more rapidly than a thrombotic stroke, but note that it is only usually, there are exceptions. In medicine, anything is possible. -
Ah I see...Originally posted by thinkdifferent:My point is, that some of my knowledge, especially in neurology is thanks to (or maybe I should say it's something for what I shouldn't be grateful as nobody would like to have it) things I have unluckily experienced on myself and have to live with them now.
Oh well, do you agree with me that the practice of carrying out a CT scan is the proper approach to the patient who is suffering from a stroke event? After all, having a stroke is a progressive event, and changes to neurological functions though acute, develops its severity over quite some time, giving the physicians and neurologists a certain amount of time to spare before infusing the patient with medications in the confidential manner rather of an empirical approach?
Personally, I have not really participated in a full management of a stroke patient before. I have at least experienced it as an assistant to the physician in charge. I am just speaking from the experience of how the specialists carry out the procedure.
If you are doubtful, could you do me a favor of asking your mom about her opinion? I am not attached to Neurology as of now, so I may not have the right specialties to refer to...
Thanks thinkdifferent! -
Hi wifeyOriginally posted by subarugal:wow.. havn't closed clinic ah..
hee... 
! No not really closed yet 
Settling the confusion of investigating stroke prior to managing them... -
Right see you then!Originally posted by ndmmxiaomayi:Time to log out. Will be back tomorrow morning to look at your answers. -
I agree with everything you said. I didn't meant that I had a stroke, I am too young for that. But who knows, maybe some stroke will like me and visits me.Originally posted by renorenal:Ah I see...
Oh well, do you agree with me that the practice of carrying out a CT scan is the proper approach to the patient who is suffering from a stroke event? After all, having a stroke is a progressive event, and changes to neurological functions though acute, develops its severity over quite some time, giving the physicians and neurologists a certain amount of time to spare before infusing the patient with medications in an empirical approach?
Personally, I have not really participated in a full management of a stroke patient before, or at least experienced it as an assistant to the physician in charge. I am just speaking from the experience of how the specialists carry out the procedure.
If you are doubtful, can you do me a favor of asking your mom about her opinion? I am not attached to Neurology as of now, so I may not have the right specialties to refer to...
Then I would say (if I still would be able to talk after that) : God, you have a sick sense for humour.
What I meant was, that it's different point of view to examine and handle patients and to be the pantient yourself. -
I see... I see... but I still need your mother's opinion on the above mentioned approach to the management of CVA... do post it hereOriginally posted by thinkdifferent:I agree with everything you said. I didn't meant that I had a stroke, I am too young for that. But who knows, maybe some stroke will like me and visits me.
Then I would say (if I still would be able to talk after that) : God, you have a sick sense for humour.
What I meant was, that it's different point of view to examine and handle patients and to be the pantient yourself.
Thanks again! -
CLINIC CLOSED
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/pops in
hmm... doctor slacking off
/pops out -
Oh, sure. Sorry, I couldn't think/concentrate properly due to my hypoglicemia. I have messed up with my metabolism, studying stress, exhaustion.
So here it comes.
A stroke isn't really a progressive even't, but depends on its type. When the blood vessels in brain are blocked - ischemia (due to spasm, trombosis or embole) certain parts of the brain don't get oxygen and get damaged. The longer this blocade takes, the bigger parts of the brain get damaged and the
damage gets more severe. Hence the faster the doctors "deblocade" the blood vessels, the bigger chance to recover for the patients and the less damage of the brain. You know, brain is sensitive on oxygen, you know what can lack of oxygen cause to the brain.
According to my mom CT is necessary to see where what happened, so that the doctors know what to do, and ofcourse fast medication to free the blood vessels, neurologist should be by the patient.The faster is the patient treated, the bigger the chance for him.
The CT scan should be repeated after 4 hours to see the changes in the brain. -
woo...got the SM goddess still awake..
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Oh...Originally posted by renorenal:A CT scan is mandatory rather than necessary according to the practice here. There is no confirm yes or no of isolated risks that can lead to TIA or CVA, as both event can occur. A TIA is partial obstruction while a CVA is total occlusion of the blood vessel. How that happens, partial or total is beyond a positive confirmation and prediction. Our best bet is through multiple papers of research and this will never also give a 100% effectiveness of what cause what, aside from being impractical.
Stroke as I have explained earlier is progressive and changes occur slowly and over time in hours or days, which splits them up into categorization of TIA and CVA.
Recovering faster or not depends on the right treatment, though I may have to agree that 90% of the time you will be right if you treat the patient with an anticoagulant as you can be 90% sure that it is thrombotic in origin. However such issues lead to improper management and care of the patient.
You need to be in the situation to recognize and understand what actually happens during that time... a neurologist will tell you different things from what I tell you, and approach of practice of managing stroke patients vary widely.
During the first 30 minutes (some time can be as less than 15 minutes taking out the time of preparing the patient and setting up the equipment) the patient is actually being scanned rather than being left alone.
To sum up, a hemorrhagic stroke is usually more deadly and progress much more rapidly than a thrombotic stroke, but note that it is only usually, there are exceptions. In medicine, anything is possible.
Is there a way to tell whether the patient from hemorrhage lesion and clot just based on the doctor's experience? I know that you said that it is better to be safe than sorry, but as with everything, there are differences. Or are the symptoms too similar that it is better to have CT scan to see if it is a hemorrhage lesion or clot rather than blindly administering drugs to the patient? -
Hemorrhagic lesion USUALLY progress faster than thrombotic lesion. The rapidity of the decline of the patient's status and condition with the Glasgow Coma Scale may be one way out if the patient's condition is very very bad.Originally posted by ndmmxiaomayi:Oh...
Is there a way to tell whether the patient from hemorrhage lesion and clot just based on the doctor's experience? I know that you said that it is better to be safe than sorry, but as with everything, there are differences. Or are the symptoms too similar that it is better to have CT scan to see if it is a hemorrhage lesion or clot rather than blindly administering drugs to the patient?
Experiences are experiences, as far as I know, the higher one's rank is, the more cautious the doctor can be rather than to be blind. Neurology is a rather in-depth subject and not to even mention it's sister's subject, Neurosurgery, Psychiatry and Psychology, since most of the human brain's are left to be explained in terms of hypothesis. The documentations are never sufficient to predict that this will happen, and that will happen, because the way it takes its course or route is very varied.
The symptoms can be very similar, only the progression is the way of seeing it. Hence with these group of patients, I as a house officer would have no say, but to immediately notify my superiors whom their decisions are best to say left it to them to make. However, if I were to be the consultant, I will pull out all investigations, verify them and get them assessed and check, and in the meantime, supporting the patient as much as the team can. It has been known that certain thrombus can be as bad as hemorrhage, not to even mention that in hemorrhagic stroke, there are plenty more differential diagnosis you have to rule out before you can say that this is a stroke.
You have to know, that our pledge before becoming doctors are to practice as safe doctors, and not gung-ho doctors based on our experience, no matter how long that can be. -
Originally posted by thinkdifferent:
Progressive as in the damaging areas, hence you can see the pattern of damage peripherally. This is what I meant actually.
A stroke isn't really a progressive even't, but depends on its type. When the blood vessels in brain are blocked - ischemia (due to spasm, trombosis or embole) certain parts of the brain don't get oxygen and get damaged. The longer this blocade takes, the bigger parts of the brain get damaged and the
damage gets more severe. Hence the faster the doctors "deblocade" the blood vessels, the bigger chance to recover for the patients and the less damage of the brain. You know, brain is sensitive on oxygen, you know what can lack of oxygen cause to the brain.
According to my mom CT is necessary to see where & what happened, so that the doctors know what to do, and ofcourse fast medication to free the blood vessels, neurologist should be by the patient.The faster is the patient treated, the bigger the chance for him.
The CT scan should be repeated after 4 hours to see the changes in the brain.
Thanks for the clarification from your mom... -
Originally posted by alexkusu:woo...got the SM goddess still awake..
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I know that they have to practice as safe doctors not gung-ho doctors. I was thinking along the line since they are going to save patients, time is important. Every minute wasted means the patient's condition would have worsen. So I asked whether experiences can help the doctor to minimize the patient's condition by administering drugs which he thinks will help the patient.Originally posted by renorenal:You have to know, that our pledge before becoming doctors are to practice as safe doctors, and not gung-ho doctors based on our experience, no matter how long that can be. -
The answer I give you is subjective, because there are no research papers to say that they will give a 100% cure or at least more than 90%.Originally posted by ndmmxiaomayi:I know that they have to practice as safe doctors not gung-ho doctors. I was thinking along the line since they are going to save patients, time is important. Every minute wasted means the patient's condition would have worsen. So I asked whether experiences can help the doctor to minimize the patient's condition by administering drugs which he thinks will help the patient.
If you read up on Pulmonary Embolism, you will see that there is actually not even a second to waste, but the patient dies off unknowingly.
Hence the correct practice is to prevent a stroke, rather than waiting for it to come, otherwise, treating it will become controversial and raises subjectivity up to a point of debate of how one will treat it correctly.
Administering drugs to minimize the deterioration of the condition as I have mentioned in earlier posts includes (going against the risk factors) anti-hypertensive, IV fluids, medications that resolves the imbalances of the body's chemicals and may be up to a point of resuscitating the patient.
Doctors are not curers of disease, there are times when nothing can be done even though the best has been done.
Let me however put it to you this way, as I want to see your opinion of managing the patient with a stroke. If you are a doctor on call, receiving one such patient, what will be your necessary step then? Remember that your objective is to help the patient and be a safe doctor as well. -
First and definitely will be to send him for CT scan.Originally posted by renorenal:The answer I give you is subjective, because there are no research papers to say that they will give a 100% cure or at least more than 90%.
If you read up on Pulmonary Embolism, you will see that there is actually not even a second to waste, but the patient dies off unknowingly.
Hence the correct practice is to prevent a stroke, rather than waiting for it to come, otherwise, treating it will become controversial and raises subjectivity up to a point of debate of how one will treat it correctly.
Administering drugs to minimize the deterioration of the condition as I have mentioned in earlier posts includes (going against the risk factors) anti-hypertensive, IV fluids, medications that resolves the imbalances of the body's chemicals and may be up to a point of resuscitating the patient.
Doctors are not curers of disease, there are times when nothing can be done even though the best has been done.
Let me however put it to you this way, as I want to see your opinion of managing the patient with a stroke. If you are a doctor on call, receiving one such patient, what will be your necessary step then? Remember that your objective is to help the patient and be a safe doctor as well.
I will ask the patient's medical history, like if he has a stroke before. If he has a stroke before, it will likely be TIA, because in previous you said that TIA has a higher chance of re-occuring again. Then I will ask if he has any health risks that is related to stroke. By testing the various health risks, I can then give him medication to minimize the health risk and to prevent another stroke from happening again.
After this, I will administer the correct drugs based on the CT scan results, like anticoagulant drugs for thrombotic stroke (don't know correct or not)
PS: answered this based on what I have learnt from your threads. -
Yes, I can see that... and that is how it is practised in Malaysia, so far the results are quite good, and we faced minimal complications after that.Originally posted by ndmmxiaomayi:First and definitely will be to send him for CT scan.
I will ask the patient's medical history, like if he has a stroke before. If he has a stroke before, it will likely be TIA, because in previous you said that TIA has a higher chance of re-occuring again. Then I will ask if he has any health risks that is related to stroke. By testing the various health risks, I can then give him medication to minimize the health risk and to prevent another stroke from happening again.
After this, I will administer the correct drugs based on the CT scan results, like anticoagulant drugs for thrombotic stroke (don't know correct or not)
PS: answered this based on what I have learnt from your threads.
Now, what if the patient is too unconscious to get a history from...