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Stroke assessment in the perioperative orthopaedic patient
Janice Weinhardt1, Kristine Jacobson
1Summa Akron City Hospital, Akron, OH, USA.
Insights
Elderly patients undergoing orthopedic surgery face increased stroke risk due to comorbidities. Prompt neurologic assessment and stroke team activation are crucial for timely intervention and better outcomes.
Area of Science:
- Geriatric Medicine
- Neurology
- Orthopaedic Surgery
Background:
- The aging global population presents with more comorbidities, increasing risks during orthopedic procedures.
- Perioperative stroke is a significant complication, particularly in elderly patients with conditions like hypertension, diabetes, and atrial fibrillation.
Observation:
- A thorough neurologic assessment, including history and physical exam, is vital for establishing a baseline.
- Orthopaedic nurses may find neurologic assessments challenging, highlighting a need for specialized training.
- Identifying focal neurologic deficits requires urgent evaluation to rule out stroke mimics.
Findings:
- Common risk factors for perioperative stroke include prior stroke, hypertension, diabetes mellitus, atrial fibrillation, carotid stenosis, and advanced age.
- Comprehensive neurologic assessment is essential for postoperative monitoring and identifying potential complications.
Implications:
- Early detection and intervention by a stroke team can significantly improve patient outcomes.
- Standardizing neurologic assessment protocols can enhance care for high-risk orthopedic patients.
- Recognizing stroke symptoms promptly is critical, as 'time is brain'.
Abstract:
A growing elderly population with an increasing number of comorbidities is presenting for orthopaedic procedures and interventions, lending themselves to greater risk for complications, including stroke. Prior stroke or transient ischemic attack, hypertension, diabetes mellitus, atrial fibrillation, carotid stenosis, and advanced age are the most common risk factors for perioperative stroke. A comprehensive neurologic assessment should include a thorough history including identification of risk factors, pertinent medications, and a physical examination. This assessment is important to establish a baseline for subsequent neurologic evaluations in the postoperative period. Neurologic physical assessment can be an intimidating task, especially for the orthopaedic nurse who lacks experience in caring for the neurologic patient. Patients who are found with a focal neurologic deficit that is suspicious for stroke require urgent assessment, exclusion of stroke mimics, and activation of the institution's stroke team to allow for brain saving interventions. Time is brain.
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