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Advisor(s)
Abstract(s)
IntroduĆ§Ć£o: Acidente IsquĆ©mico TransitĆ³rio (AIT) Ć©, classicamente, definido como
conjunto de sinais clĆnicos de um distĆŗrbio focal ou global, da funĆ§Ć£o cerebral ou
retiniana que se desenvolve rapidamente, com duraĆ§Ć£o inferior a 24 horas e sem
causa nĆ£o vascular aparente. Em 2002, foi proposta uma nova definiĆ§Ć£o, que reduzia
a duraĆ§Ć£o do episĆ³dio a menos de 1 hora e sem evidĆŖncia de enfarte agudo (1). Um
estudo de Maio de 2009, propĆ“s nova definiĆ§Ć£o como sendo āum episĆ³dio transitĆ³rio
de disfunĆ§Ć£o neurolĆ³gica, causada por isquemia cerebral, medular, ou retiniana focal,
sem enfarte agudoā (2). Estima-se que ocorram nos EUA cerca de 200.000 a 500.000
mortes anuais relacionadas com AIT (3). Portanto, exige-se uma avaliaĆ§Ć£o e
tratamento preventivo imediato para reduzir o AVC, a incapacidade e morte. A NSA
recomenda a criaĆ§Ć£o de polĆticas de internamento hospitalar e um protocolo de
referenciaĆ§Ć£o rĆ”pida, de avaliaĆ§Ć£o clĆnica e encaminhamento para Unidades de
tratamento especializadas (1).
Objectivo: Criar um Protocolo ClĆnico, para aplicar no Centro Hospitalar Cova da
Beira.
MƩtodos: Recursos bibliogrƔficos de artigos apropriados ao tema fornecidos por parte
do orientador. Pesquisa bibliogrĆ”fica no Pubmed, Medscape e Doctorās Guide com as
keywords: Transient Ischemic Attack, management, definition, emergency department,
diagnostic protocol, guidelines, evaluation, accelerated diagnostic protocol. Revistas do
tema disponĆveis on-line.
Resultados e DiscussĆ£o: O protocolo inicia-se com uma checklist, que define os
principais sintomas a pesquisar pelo profissional de saĆŗde que recebe o doente no SU.
Inclui tambĆ©m, para inĆcio da avaliaĆ§Ć£o, a data e hora de inĆcio dos sintomas,
observaĆ§Ć£o respiratĆ³ria, cardĆaca, PA, FC, oximetria e sinais de disfagia. Procede-se Ć
colheita sanguĆnea para anĆ”lise laboratorial que inclui hemograma completo com
plaquetas, provas da coagulaĆ§Ć£o, glicemia, avaliaĆ§Ć£o hepĆ”tica e renal, ionograma,
PCR ou VS. Realiza-se ainda de imediato TC CE e ECG. Caso o doente apresente
sintomas persistentes, deve-se reencaminhar para Protocolo de AVC. Se os sintomas
reverteram, iniciar tratamento antiplaquetar e avaliar critƩrios de internamento,
incluindo escala ABCD2. Caso o doente reĆŗna critĆ©rios de hospitalizaĆ§Ć£o Ć© enviado
para UAVC, onde realizarĆ” os restantes exames complementares de diagnĆ³stico
imagiolĆ³gicos, conforme o algoritmo. De desmedida importĆ¢ncia nesta fase temos o
EcoDoppler carotĆdeo que, caso evidencie sinais patolĆ³gicos com estenose superior a
50%, indica necessidade de endarterectomia, com melhores resultados se realizada
em 2 semanas. Outros exames de grande importĆ¢ncia sĆ£o a ecocardiografia
transtorƔcica, AngioTC e Eco Doppler transcraniano. Todos os factores de risco
devem ser tratados, e sĆ³ prescrita alta clĆnica se cumprir todos os critĆ©rios e sempre
acompanhado de NotificaĆ§Ć£o Informativa para o mĆ©dico assistente, com todas as
informaƧƵes importantes necessƔrias a um bom acompanhamento posterior.
ConclusĆ£o: Um protocolo de actuaĆ§Ć£o rĆ”pida, faculta maior eficiĆŖncia no tratamento,
menores custos associados e resultados clĆnicos semelhantes ou melhores.
Introduction: Transient Ischemic Attack (TIA) is classically defined as a group of clinical signs of cerebral or retinian functionās focal or global disturbance developing hastily, with a duration inferior to 24 hours and with no apparent vascular cause. In 2002, a new definition that reduced the episode to less than 1 hour and with no evidence of acute infarction, was proposed (1). Mayās 2009 study, suggested a new definition, as being a neuronal disfunction transitory episode caused by ischemia arising from cerebral, spinal or retinian focal, without acute infarction (2). It is estimated that there are about 200.000 to 500.000 annual deaths related to TIA (3). In order to reduce Vascular Cerebral Accident (VCA), incapacity and death, it is demanded immediate evaluation and preventive treatment. NSA recommends creation of hospital internment policies and a quick referentiation protocol of clinical evaluation and guidance to specialized Treatment Unities (1). Objective: Create a Clinical Protocol to apply at Centro Hospitalar Cova da Beira Methods: Bibliographic resources from theme appropriate articles given from the advisor. Bibliographic research at Pubmed, Medscape and Doctorās Guide with the following keywords: Transient Ischemic Attack, management, definition, emergency department, diagnostic protocol, guidelines, evaluation, accelerated diagnostic protocol. Online theme related magazines. Results and Discussion: The protocol begins with a checklist defining the main symptoms that the healthcare professional should look for after receiving the patient at the Emergency Room. It also includes, for purpose of initial evaluation, beginning of symptomsā date and hour, respiratory and cardiac evaluation, arterial blood pressure, cardiac frequency, oximetry and disphagic signals. It is then proceeded to blood samples collection for laboratory analysis that include complete hemogram with platelets, coagulation tests, glycaemia, hepatic and renal evaluation, ionogram, PCR and VS. An immediate TC CE and ECG are also performed. In case of persistent symptoms the patient should be directed to VCAās Protocol. If the symptoms revert, antiplatelet treatment should be initiated and internment criteria should be evaluated, including ABCD2 scale. If it is the case that the patient fulfils hospitalization criteria, the patient should be sent to VCAās Unity, where the rest of imagiologic diagnostic complementary exams will be done, in conformity with the algorithm. Carotid EcoDoppler is of immeasurable value at this phase and if it demonstrates pathological signs with more than 50% stenosis an endarterectomy is needed and should be carried out in 2 weeks as it presents better results. Other exams of great importance are transthoracic echocardioghraphy, AngioTC and transcranial EcoDoppler. All risk factors should be treated and hospital discharge is only given if the patient accomplishes all criteria. The hospital discharge should always be accompanied by an Informative Notification, with all important and necessary information for a good posterior accompaniment from patientās assistant physician. Conclusion: A quick actuation protocol grants more efficiency on treatment, less associated costs and similar or better clinical results.
Introduction: Transient Ischemic Attack (TIA) is classically defined as a group of clinical signs of cerebral or retinian functionās focal or global disturbance developing hastily, with a duration inferior to 24 hours and with no apparent vascular cause. In 2002, a new definition that reduced the episode to less than 1 hour and with no evidence of acute infarction, was proposed (1). Mayās 2009 study, suggested a new definition, as being a neuronal disfunction transitory episode caused by ischemia arising from cerebral, spinal or retinian focal, without acute infarction (2). It is estimated that there are about 200.000 to 500.000 annual deaths related to TIA (3). In order to reduce Vascular Cerebral Accident (VCA), incapacity and death, it is demanded immediate evaluation and preventive treatment. NSA recommends creation of hospital internment policies and a quick referentiation protocol of clinical evaluation and guidance to specialized Treatment Unities (1). Objective: Create a Clinical Protocol to apply at Centro Hospitalar Cova da Beira Methods: Bibliographic resources from theme appropriate articles given from the advisor. Bibliographic research at Pubmed, Medscape and Doctorās Guide with the following keywords: Transient Ischemic Attack, management, definition, emergency department, diagnostic protocol, guidelines, evaluation, accelerated diagnostic protocol. Online theme related magazines. Results and Discussion: The protocol begins with a checklist defining the main symptoms that the healthcare professional should look for after receiving the patient at the Emergency Room. It also includes, for purpose of initial evaluation, beginning of symptomsā date and hour, respiratory and cardiac evaluation, arterial blood pressure, cardiac frequency, oximetry and disphagic signals. It is then proceeded to blood samples collection for laboratory analysis that include complete hemogram with platelets, coagulation tests, glycaemia, hepatic and renal evaluation, ionogram, PCR and VS. An immediate TC CE and ECG are also performed. In case of persistent symptoms the patient should be directed to VCAās Protocol. If the symptoms revert, antiplatelet treatment should be initiated and internment criteria should be evaluated, including ABCD2 scale. If it is the case that the patient fulfils hospitalization criteria, the patient should be sent to VCAās Unity, where the rest of imagiologic diagnostic complementary exams will be done, in conformity with the algorithm. Carotid EcoDoppler is of immeasurable value at this phase and if it demonstrates pathological signs with more than 50% stenosis an endarterectomy is needed and should be carried out in 2 weeks as it presents better results. Other exams of great importance are transthoracic echocardioghraphy, AngioTC and transcranial EcoDoppler. All risk factors should be treated and hospital discharge is only given if the patient accomplishes all criteria. The hospital discharge should always be accompanied by an Informative Notification, with all important and necessary information for a good posterior accompaniment from patientās assistant physician. Conclusion: A quick actuation protocol grants more efficiency on treatment, less associated costs and similar or better clinical results.
Description
Keywords
Acidente isquĆ©mico transitĆ³rio Acidente isquĆ©mico transitĆ³rio - Tratamento Acidente isquĆ©mico transitĆ³rio - DiagnĆ³stico Acidente isquĆ©mico transitĆ³rio - AvaliaĆ§Ć£o
Citation
Publisher
Universidade da Beira Interior