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Nu//HzHzNuHzHz:Nu8HzHz(Nu6?/-D/-H/-^/-bHzHzNuS@Ofp0ЀA1`p0ЀABp&(NuO>?|?| HWNOONuH $ov8/`.?/ NO@\Of?+HAT+HA+HA+HA+HAv+HA+HA5r+HA7j+HAV+HAoh+HAA+HAC+HAi+HA@+HAz+HAkj+HAoR+HAC+HAnL+H Ah+H$A+H(A+H,A +H0A V+H4A +H8A +H&(NuUUUUUUUU/ /OHzHzNuHzHz^NuHzHzNuBW/-/-HzHzNu@EEJPOf6HoHzHzNuRoRoUo Uo Ho?/NOO `p f6HoHzHzNuRoRoUo Uo Ho?/NOO `4HoHzHzNuRoRoUo Uo Ho?/NOO O &$_Nu/HzHzӬNuHzHzNufb m/(/(tNOPO? m*/(/(tNOPO? mD/(/(tNOPO? m^/(/(tNOPO?NOPO` f` m/(/(tNOPO? m*/(/(tNOPO? mD/(/(tNOPO? m^/(/(tNOPO?NOPO`^ m/(/(tNOPO? m*/(/(tNOPO? mD/(/(tNOPO? m^/(/(tNOPO?NOPO&Nu/HzHz:NuHzHzђNufF m*/(/(tNOPO? mD/(/(tNOPO?/-^NOXO?/-^NO O `D m*/(/(tNOPO? mD/(/(tNOPO?/-^NOXO?/-^NO*O &Nu/-NO/-NONOPONuH:HzHzѰNu&mvfHxNO(H XOf?<` N^TO/ NO!&H&v/-^NOR@r2XO/NO$H POf?<` N^TO/ NO!,H/-^/NO/ NO"'J+Lv/ NO5 LO`J/ NO!$H/*NO!(H/-^/ NOJ@Of/ NO5/ NO5 KPO`/ NO5&R/ NO5PO`L\NuH8OHzHzШNu&mvf.AHPHoNO/-^Ho NOHoNOHxNOO/ NO!$H/*NO!(H/-^/ NOJ@Of/*NO"/ NO" KO`/*NO"&R/ NO5PO`~LNuCan't locate draw window=/ / OxHzHz.Nu$H f.ArHPHoNO/-^Ho NOHoNOHxNOO/ 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HzHzNuO`5oHzHz2Nu<?*/ NO^POXOL Nu/ / YO?<HzHzNuHzHzNuHzHzNu$H&j/ HzHzNuJ\Of?<HzHzNuTO`Z?*/ NO\p0*/@Ho?*Hj/ HzHz Nu5oHzHz`Nu<?*/ NO^OXO$_&_Nu o ogAHPNOHxNOPONuaccessing an unopened databaseBgHzHz"NuTONu?/HzHz NuTONuQO0o /HotNOHo` NONu/?/////HzHzNu60O &NuH8O&o2$o6?o: /sf6/glv`Nov`Dv`>/ / NO6PO`.IIHg./+/+tNO(&POlv`ov`v`gb/R/j/S /k////////t'NOJOgv`////////t)NOJOgv`v`gL/+/+t NO/@/R//// tNOJOgv`L////tNOJPOgv`4v`0g(/+/+tNO86CPOlv`Cov`v`v0OLNup$$r2 mANu mfg /-NOXONuNO g*BNOBNOBgNOs/NO/-NO+mfOHzHzNu;@?-NO+H/-NO/-NOO NuNO g/-NO+mfXONuH OBBHzHzlNu$mbP6 CdB mb (sfAHP` NXO`jHo` NXO`P mb (sg6B'0H r2/Aj"HC R//-bNO~O`/-bNO+H/-NO"Aj*A&(&R mb"H0)H r2҃//-NOb+HOf?<t` N^TO/-NO!+HbHxHmb0(Hr2//-NOvAj*A&(&R mb"H0)@ r2҃?AHoHh/-b` NdB' mb"H0)H r2///-bNO~O.O L8NuH:*/",o&Jmo?<&/-NO_$H \OfA|HPNOHxNOPO/ NO!(H8/$6C8Lv6G8/ HzHz2Nu6 E0HkHzHzNu?-@?-B/-D/-H?-HzHzNu -O f.?-$?-&?-(/-*/-.?<HzHz~NuO`,?-$?-&?-(/-*/-.?<HzHzPNuONu;|"NuBm"NuH0:-v`^0H m$p gL*H@U@f / NOXO`4B0-C?/`v<`:???/-bHzHzNu+H^???/-HHzHzNu+HD;G\;FZ;EX mb (sOf/-D` NXO`/-D` NXORC mHh elRD mHh eVRW mH0he>` mb (sf/-D` NXO`~/-D` NXO`dTOLNuWrong number of func args d<NOSTOfNu<NOJTOg <NO4TONu;|b m`fNO%Nu2/"o o p`R@AmNuH /-^/-b` N&/-D/-H` N(+D>+| B;|F;|FH;|JB-LB-M|NBPB-;|,J-Og(Hm AHPNO;m O`JAHPHoNOJ@POfP/-D/-HHzHzNu8HoHoV?<?- t NOg6 COg CfpJ`A,HPHoNOJ@POfn/-D/-HHzHz:Nu8HoHoV?<?- t NOg6 COfpJpJ`j Cf pJ`Z CfRpJ`HAHPHoNOJ@POfX/-D/-HHzHzNu8HoHoV?<?- t NOg6 COf pJ` CfpJ`ANHPHoNOJ@POfX/-D/-HHzHzLNu8HoHoV?<?- t NOg6 COf pJ` CfzpJ`pAHPHoNOJ@POfX/-D/-HHzHzNu8HoHoV?<?- t NOg6 COf p J` CfpJ`AHPHoNOJ@POf|/-D/-HHzHztNu8HoHoV?<?- t NOg?^6 COg Cf p@J` Cf J` CfJ`tAHPHoNOJ@POf/-D/-HHzHzNu:8POf2HxB?< ?- t NOgHxB?<?- t NOg6O`( Df2HxB?< ?- t NOgHxB?< ?- t NOg6O` DfHxB?< ?- t NOgHxB?<?- t NOg6O`A,HPHoNOJ@POfT mD/(/(B/<@YHot4NOO/(/(tNO/@HoHo?<?- t NOg6O`NAHPHoNOJ@POfF/-D/-HHzHzNu6 CWD@HoHo?<?- t NOg6O`AHPHoNOJ@POf$/-D/-H` N;@FvPO`APHPHoNOJ@POf$/-D/-H` N;@HvPO`A HPHoNOJ@POf0/-D/-H` N6POf|L`B-Lv`@AHPHoNOJ@POf$/-D/-H` N@MvPO`AHPHoNOJ@POf$/-D/-H` N@NvPO`AHPHoNOJ@POf&/-D/-H` NH+@BvPO`A\HPHoNOJ@POf$/-D/-H` N;@JvPO`^A,HPHoNOJ@POf/-D/-H` N;@,J(POg /-(NOXOp!m,r2/NO$H XOf?<` N^TO/ NO!+H(p!m,?/-(?- tNOgvO `AHPHoNOJ@POf$/-D/-H` N;@ vPO`AlHPHoNOJ@POf2 e$/-D/-H` NPO?tNOTOv`BHoA4HPHmNOHmNOHxNOOHoHoN?<?- t NOg6O ?HzHzNuTOONL8NuheapvariablecounttimerbaudratestopbitsparityxonxoffrtsautoctsautobitspercharirctstimeoutdtrassertdtwaitdcdwaitdialtonehandshakeautobaudcmdtimeoutvolumebuffersizeportidcoordinatesystemUnrecognizable set parameter=%s/ /OHo:?- NO6?HzHz NuJCPOf>/-^Ho NOHoHoNOA,HPHoNOJ@Of&/-D/-H` N/@B+@>PO`AHPHo NOJ@POf Cfp>`vAHPHo NOJ@POfh/-D/-HHzHzzjNu POfE:Ep`* fE:Ep` f>`A@HPHo NOJ@POf@/-D/-HHzHzyNu POf p>` f>`AHPHo NOJ@POf@/-D/-HHzHzyNu POf p>`f f^>`RAHPHo NOJ@POf@/-D/-HHzHzyFNu POf p >` f >`A\HPHo NOJ@POf/-D/-HHzHzxNu6 CPOf ?>` CfE:E?p@` CfE:E?` CfE:E?`bAHPHo NOJ@POf: mD/(/(B/<@YHot4NOO/(/(tNO/@JPO`AHPHo NOJ@POf$/-D/-H` N;@FvPO`AZHPHo NOJ@POf$/-D/-H` N;@HvPO`A*HPHo NOJ@POf0/-D/-H` N6POf|L`B-Lv`pAHPHo NOJ@POf$/-D/-H` N@MvPO`8AHPHo NOJ@POf$/-D/-H` N@NvPO`AHPHo NOJ@POf&/-D/-H` NH+@BvPO`AfHPHo NOJ@POf$/-D/-H` N;@JvPO`A6HPHo NOJ@POf/-D/-H` N;@,J(POg /-(NOXOJ(f?<` N^TOp!m,r2/NO$H XOf?<` N^TO/ NO!+H(p!m,?/-(?- NOvO `AHPHo NOJ@POfT/-D/-H` NPOfHxB?< ?- NO6O `HxB?< ?- NO6O `nA(HPHo NOJ@POf"/-D/-H` N;@ vPO`8HoAHPHmNOHmNOHxNOOZ`(Ho:?- NO6\O?HzHzNuTOOF&$_NubaudratestopbitsparityxonxoffrtsautoctsautobitspercharctstimeoutdtwaitdcdwaitdialtonehandshakeautobaudcmdtimeoutvolumebuffersizeirportidUnrecognizable serial set parameter=%sH0YO/-D/-H` N&J-POgB?- NO\O`B?- tNOg\O mb (sf8J-gHW//-^?- NOO` HW//-^?- t NOgO`/-D/-H` N&p0-,POcv6-,$mbP8p0cv6 R/NO&H XOf?<` N^TO/ NO!$HxAjA,Aj*XO`.0H mbAhA/(/(tNO?@  @RDPO0DeJ-gHW// ?- NOO`HW// ?- t NOgO/ NOXOJ-g>NOr2 ` N"<,` N/?- NO \O` ?- t NOgTO?HzHzNu\OL xNuH0O/-D/-H` N&p0-,POcv6-, mb (sg$HP8p0cv6 m*/(/(B/<@YHot4NOO/(/(tNO. R/NO&H O f?<` N^TO/ NO!$H*J-XOf.|`&J-g//?- NO?@ O `//?- tNOg?@ O 8/gX DgR DfBJ-gNOr22p0/?- NO\O`NOr22p0/?- tNOg\ORF F mp8/J-gHo?- NO\O`Ho?- tNOg\O?@d/CJ-gHoB/// ?- NOO`HoB/// ?- tNOgOJof?D?/HzHzNuTO`` -fB// HzHzNu/@B'HzHznNuBgHzHzNuO `?<HzHzNuTO /B2 mb (sf/ ` NXO`pv`0B/r0B?/-^/-b?/` NRCO0Ce//Ho tNO mH(@POfHo` N XO/ NOOL Nu//-^/-DHxHm) g"(ir4`p`" f?C` f?C` f?C?/?/?/?//-NONOs"O f /-NOXOPO&(Nu/HzHzuNu<HzHz:NuHzHzvNu/-D/-HNOs/HzHz NuO&Nu////HzHzj>NuPO?/-NO[\ONu<HzHzNuHzHzv0Nu/-D/-HHzHzNuO NuH:UO$o",o&:/,SE Elz6?/NOv\O`d8?/ NOS\OfR?/ NO&H/ ` NWO f.// ` NT@?@?/ NOoOg"RC/ NO@XOeNOsf/NOXO` Ef@AHPHx` N,H/` N*(HB/ / NOO`f6AHP?/NO\O/NOR@r2XO/` N(/` N*(H?/NO\O// NO/ / NOO/ / ` NTPO?HzHzDNu,H&.TOg/` N$XO-LNOsf/ NO XOTOL\8Nulablab/ <HzHzؼNuHzHzt&NuNOs$H/-D/-HHzHzgNuPO??</-/ HzHzNuO$_NuH:O(o,6/0&o2 Cg CgJCgD`^AdHP/ NOR@r2XO/` N(H/ ` N*$H/ / NO/-NO/ /-NO?-HzHzNu&H(k O"g/ ` N$XO'J/-NO O`?-NOs/` N\ONOdHo?-/ NO\O?/ NONOg??-/ NO\O/NOXO??-/ NO\O/NOk\O??/?/HoNOBgHoNONOdA>HP?-/ NO\O/NOR@r2XO/` N,H/` N*$H< / NOSXO// NO'B'Hx/ NOAXO/NO'/ NO/@D/ NOr2HOHd/ NOr2XO// / NO&O `/ NOSXO// / NO&O / ?-/ NO?-HzHzVNu&H(k O g/ ` N$XO'J`/ ?-/-HzHzVNuO OL\NusetLabsetLab2H <HzHzծNuHzHzpNuHzHzoNuNOs$H?-/ NO6?/ NOr8/-^?/ HzHzNuOLNu?/ /-NONOs \Of /-NO XONu/<HzHzNuHzHzoXNu6??<NOs/HzHzNuO &Nu/<HzHzNuHzHzoNu/-^/-bHzHzcNu6??<NOs/HzHz:NuO&NuO//A"HPHoNOHo NOHxNOONuWrong type of variable used in call to set property for '%s'O//A"HPHoNOHo NOHxNOONuWrong type of variable used in call to get property for '%s'O?///A"HPHo NOHoNOHxNOONuCannot set property (%s) on control type %dO?///A"HPHo NOHoNOHxNOONuCannot get property (%s) on control type %dH z8/`:p mP?0NO~$HvTO`?/ NO@\Of J`RC/ NO@XOeRE6meL8NuH:O,/$,o(z`p $mPE?*NO~"F"AHP?*//-*/-.HzHz]0NuPO??/-//HzHz,NuO ` :RE?//NO+H?//NO;@/-*/-.HzHz\NuPO??/-//$HzHzNuO` |A HPHzHzNuXO` `JCg?A HPHzHzNu\O` > m. (sg/-*/-.HzHzNuPO` A nHPHzHzhNuXO` C g?A THPHzHzNu\O` m. (sg(/-*/-.//<HzHzNuO` A HPHzHzNuXO` Cf/-` N]XOg/-` N_XOf| m. (sgTHoHoHo Ho /-NO/-*/-.HzHz[A HPHzHzNuXO`" Cg?AHPHzHzBNu\O` m. (sg$/-*/-//` NJO `AHPHzHz"NuXO` Cg?AHPHzHzNu\O` m. (sg$/-*/-//` NPO `^A>HPHzHzNuXO`B Cg?A HPHzHzbNu\O` m. (sg$/-*/-//` NO `AHPHzHzBNuXO` Cg?AHPHzHzNu\O` m. (sg$/-*/-//` NbO `~AHPHzHzNuXO`b Cf/-` N XOg f4 m. (sgTHoHoHo Ho /-NO/-*/-.HzHzU(Nu?@"Ho"Ho$Ho&Ho(/-NOO0`AHPHzHz(NuXO` C fP m. (sg(/-*/-.//<HzHzbNuO`~AHPHzHzNuXO`b Cg?A|HPHzHzNu\O`> m. (sg$/-*/-//` NzO `A6HPHzHzbNuXO` Cg?AHPHzHzNu\O` m. (sg$/-*/-//` N2O `AHPHzHzNuXO` Cg?AHPHzHzNu\O`^ m. (sg$/-*/-//` NO `.AtHPHzHzNuXO` Cg?AXHPHzHz2Nu\O` m. (sg$/-*/-//` NhO `AHPHzHzNuXO` m. (sg6Ho?//NO?//NOWOf BgHo NO\O?//NO\O?//BgHzHzNu/-*/-.HzHzRZNu?@ jOf5o46Ho?//NO?//NO\O?//?<HzHz>SGO0G/// NO&0G*'X0CR@HH/AX/0HA/NO&O0R@?/ /NO(j O g/ ` N$XO%K0R@5@J(g: /Bf2v`?NOs/NO\Of /NOXO`RCNOs/NO@XOeL\Nuindex (%d) is invalid for list.add operation.addLstaddLst3/ /NOs$H<HzHzNuHzHzUNuHzHzUTNuHzHzTNu/-^/-b/-D/-H?-/-/ HzHz(NuO&$_NuH8(o og o fBgHx/ NO?/(HzHzۈNu$H&j O g?*/ HzHz۲Nu\OBBjv`?NOs/NO\Of / NOXO`RCNOs/NO@XOeLNu/ <HzHzNuNOs$H?-/ ?< /-HzHz,NuO$_Nu/ <HzHzNuNOs$H?-/ ?</-HzHzNuO$_NuHYOzHzHzRNuH@ig_@g]@gJ`B'HzHz*NuTOg?-HzHz(Nu/H?-//NO8PO`HzHzS`NuNOs./-DHoHzHz8Nu8PO`4HzHzS,Nu/-D/-H` N8NOs/HPO/NO@@XOcAHPNOHxNOPO<?//NO+H?//NO;@O f?//NOr6\OHzHzQvNu<0` N&L>`^<z 8FtGHI.KjLJg?-//BgHzHz&NuPO`Jg?-//?<HzHzNuPO` Cg$ Cg?AHPHzHzNu\O`hHzHzRNuHzHzQNuHzHzPZNu m. (sf Cf6/-*/-./-D/-H?-/-//HzHzdNuO`6RC?//NO+H?//NO;@/-*/-./-D/-H?-/-//$HzHzNuO(`AHPHzHzNuXO`z Cg* Cg$ Cg?AHPHzHzNu\O`J Cf(?-//?</-HzHz|NuO ` Cf/-//` NPO`6RC?//NO+H?//NO;@?-//?< /-HzHzNuO` Cg$ Cg?AHPHzHzNu\O`HzHzP4Nu m. (sg Cf,/-*/-.?-/-//HzHzNuO`66RC?//NO+H?//NO;@/-*/-.?-/-//HzHzNuO`A,HPHzHzFNuXO` C g?AHPHzHzNu\O`?-//` N\O` C g?AHPHzHzߴNu\O`h?-//` N\O`J C g?AHPHzHzrNu\O`&HzHzNNu/-*/-.?-// ` NO`Jg C g?-//HzHziNu\O`JCg?A4HPHzHzNu\O`?-//HzHziNu\O` Cg?AHPHzHzުNu\O`^/-//` NPO`@ Cg?AHPHzHzhNu\O`/-//` NPO` Cg?AHPHzHz&Nu\O`/-//` NPO` Cg?AJHPHzHzNu\O`/-//` NPO`z Cg?AHPHzHzݤNu\O`X/-//` NPO`< Cg?AHPHzHzfNu\O`/-//` NPOXOLxNuControl position too high.additemadditemcleardeleteitemdeleteitemstartCapturestartCapturestartCapturesetFocusAddDeleteColTypeBindToDatabaseColTypeColTypeHzxNu/OfJof"|lB^NO/P*A*.NO Ho.NOJ@XOfHzHzNuNO *`PNO *BNO/PbAb.NO HofNOJ@XOfHzHz"zNuNO b`NO b -lg -nfz<NO lnchTOf BBgAlHPBgNOE\O/BgNOO `HHo&Ho<<NOTO// C g8 Cg2 Cg, Cg& CSf o f ogHoNOJXOfHWHo/-NOJO fHoHzHzNuJXOfHoNO oXOfEE:6 Ce Ccd Ce CcX Ce CcL CgF Cg@ Cg: Cg4 C g. C g( Cg" Cg Cg CSf" o f of f Jmbfx` ofh of -lf|o -nf|o|zHx?<&HzHzUNuO L8NuH $ov RfTB-8*6?NO~$H TOd f?NOo$HTO` ?NOo$HTO/ NOtHz/ NOvO LNuH:O$oFv j)fp`n Rf BmhBmfBmd:80HzHzxNu `!  J  8 f b 4 0 N ( Fx Z B 2   l   ! "@v` `b;jNOs&H?*/ NO:8/ NO@@O d :RE8?/ NO \Of n?/ NO\O//* HzHzNuPO` HNOs&H?* / NO\O?/ NOJ\Of &;j HzHz Nu` ?*` N&H0*k&7@"7j TOHzHz Nu R f/* HzHzpPNuWXOg"|tHx?*HzHzSNu R"\Of?*NOs/NO8:\Og<F6?NOs/NOJ\Of^68D6?NOs/NO&H?NOs/NO2*A@O f/* / B'0*j?HzHzNuO `h?NOs/NOW\OfVJEgR?NOs/NO2*A@\Of8:8D?NOs/NO&H0*j??/ HzHzNuOv` HzHz Nu|tHx?*HzHzQNuv\O` TBmHzHzNuNOs$H/ HzHzkNu&HvXO`"8?/ NO\Of?/ NO;@\O`RC/ NO@XOev;|l` 8*6 C'e C'bv` HzHz NuNO/NONO/NOBNOBgNOs/NO+mf|mHx?*HzHzPNuvO` jv` dBmb;|`8*6 Ce Cb;|`8*6 Cg C f;|`8*6 Ce Cb;|` jSf, j f$ j f<` N;|`TO6*0HzHztNu ~Z ^ bf"&* .Z|j`h|j``|j`X|j`P|j`H|j`@|j`8|j`0|j`(|j` |j`* @j;|``CjB-k;j h;jf;j dNOs(HNOu;@|vHx0<*0m?HzHzObNu| Jmb\Of8*6 C g C g Cg Cfv`n?/ NOJ\Of2Ho?/ NO\O/NOO8/ NO@@O g2/f(p@/Sf:RE8?/ NO \OfHoHoHo?/ NO\O/NO<*: E Og Ef*0/oodh<?/?/ NO\O/NOLPO`LJog$0/odB'?/?/ NO\O/NOLPO`"0/oeB'?/?/ NO\O/NOLPO?/ NO\O/?/ NO\O/HzHzNuPO`,?/ NOU\Of8g0@?/ NO \Og?/ NO&H j \Of/ NO?@/ NO?@ / HzHzkNuoo O l$/ NO?@/ NO@?@/ HzHzkNuo oO o$/ NO?@/ NOo PO?/ NO\O`/ NO?@/ HzHzkjNuo PO?/ NO\O`/ HzHzkDNuJ@XOg0/ NO?@/ HzHzk"Nuo POl Bg/ NO\O`P/ NO?@/ HzHzjNuo POm,/ NO?@/ HzHzjNuo PO?/ NO\O/ NOXO`?/ NOW\Ofv?/ NO,H?/ NO\O?` N&H:*8 D POg Df?+,?/HzHzNuPO`0+,D@??/HzHzNuPORC/ NO@XOev`"v`JmgNOsfBmb;|`;j;jjNOs -fB-`NOu;@J-f,|vHx0<*0m?HzHzK0Nu| \OJmbfJ-fNOs&Hx`r6?/ NO+H?/ NOr: EO g E g Ef<|~ EfHo ?</HH//-NOv?C0Ho0 mHh/-HzHz\NuB0B4Ho0 mAXHh/-HzHznNuO4OLxNuOut of Memory 2H:QO?</BjA.HP0HH/HzHz(NNu(%Dv?EdO `??/Z/ NO\O/NO&H \Of 0H DB`fRjAHP/ NOR@r2XO/HzHz&Nu*/HzHz)6Nu,H/ NOR@r2XO// /NO&0H D!ORCGml`/ / HzHzTNuPORF o^h mRoP0/Pmm/-NO"/-NOa` N|iHx?<&HzHz%RNu|?-NOpOObL\NuCan't find program's PRC file.Can't open PRC file!-bscNSBasic..pdbNSBasic..pdbNSBasic..pdbCan't open rsc file.Can't find program's base recordNot enough memory to allocate program variables(%d)Sorry--the program file being executed is corrupted. Please replace.Sorry--programs generated with the free demo version expire after 5 days and must be recompiled.(created %d/%d/%d)flddvtocCan't find view TOC recordvwElemsvwObjsFldTxtCtlTxtLstPtrLstTxt/;|`NOsNOu6HzHzNu|vHx0<*0C?HzHz# Nu| B-_\O&Nu?/A"HPHmNOHmNOHxNOONuCannot continue--Out of memory(loc=%d)Hx// / ///NOvONuHx// / ///NOvONuHx// / ///NOvONu//NOHxNOPONu//O`?/AHPHoVNO6/HoZNOǰCOc4AHPHoTNO8PO`AvHPHoTNOPOHoPNOǰDXOe`<8`*HoPHoNOAHHPHo\NOHoHodNOOHoPNOǰDXOeHoP//NOO&(Nu%d*0// // tNOPO///tNOPONu/QO////tNO&BB//(//(t*NOJOf./////Ho tNOPO/(/(t&NOJOgS///tNOO&Nu/QO////tNO&BB//(//(t'NOJOf./////Ho tNOPO/(/(t&NOJOgR///tNOO&NuOBB//$//$t'NOJOg"////Hot2NO/P /hO ` ./o o !oONuH0O^Bo:Bo&//HotNOHoxNO @O cvHopNOr2At 0eXOgHopNOr2At 0EXOfBHopNOr2AtXOHpHo NOHo$NO?@2Ho|NOr2AB0OHopNO @XOcvHopNOr2At 0eXOgHopNOr2At 0EXOfBHopNOr2AtXOHpHo NOHo$NO?@2Ho|NOr2AB0OHW?</ 8`A>08`Jf  Ro:` RD`VHopHo6tNO?/BHo` N\O//////F//FHo,t4NO /-ZOg /+>fv`v0R@G>GE>E0` / / NOPO  g /+>fHo?HoBNOPOx|v`80C*E>EXH@-gS@g 0g| f RD Do RCHo>NOǶ@XOeHo>Ho6tNO// // //F//FHoJt3NO/oND/oRH?/BHo*` N\O//,//,//P//PHoTt4NO o X!o\OL NuH8OACp"QBB//F//Ft'NOJOgz-//>//>Hot2NOO `z+/o:|/o>/o|:/o>v////BBt%NOJOf\/<@/Hot3NOO/(/(tNO(/HoVNO/HotNOPO/(/(//V//VHobt5NOBB//r//rt'NOJO4g/|;^9 B/|^F`HoJNO @ XOf$//F//F/jHoRt3NOO`"//F//F/<0:/<>5yHoRt3NOOHoJNO @ XOf4///N//Nt'NOJOgD/|;^9 B/|^F`2/z//N//Nt'NOJOg/|;^9 B/|^F/oB/oF Ho////tNOHoNO @OcxHoNOr2A 0eXOgHoNOr2A 0EXOfDHoNOr2AXOHpHo:NOHo>NO8HoNOr2AB0O`HoNO @XOcLHoNOr2A 0eXOgHoNOr2A 0EXOfHoNOr2AXOHpHo:NOHo>NO8HoNOr2AB0O DllJDoh<HoNO@@XOc,HoNO@2@p0AAXOHPHoNOPOHoHoNOoB/HoHoNOO`b Do\JDlXHoHoNOAHPHoNO0D,A&HphHoNOAAAABHoHoNOO JCo -f |-B/`B/ ClHoJHoNO8HoNODr2AB00C/AA/HoNOr2AAXO/NO&HoNO@@Od"AHPHoNOAHp0HoNOOv`oJ|.B/HoKHoNOHoHoNOHoZNO@@O`8DD -f |-B/`B/HoNO6<HoNNOǼ@POd` GfRF`RERCHoNOǶ@XOe>86+g>6+g8AHPHo4NOvPO`AnHPHo4NORCPOWmJDgAVHPHo4NOPOv`ADHPHo4NORCPODm/ ???Ho Ho>HzHzNuOLNu-n.0H:Oz&o$oBoz|x`Z0D&I8 -gH +gB ,g< +g6 #g nf?| .f:` 0g ng #f EfRFRD/ NOǸ@XOeAHPHo NOżoPOmzxv~ R /+f~+RD` /-f~-RD`Nu#n#p+&,0- 08nH -ft0RCA`f0RCA`X0RCA,`H0RD2RCA`40RD2RCA` 0RD2RCA` 0RCARE`60E,IhgH@#gV@ g U@g"@>g`^0RCA. 2.@fTRD`PJ2@f0RCA0`:0RD2RCA`&J2@g 0RD2RCA` 0RCARE`hAB00Ho//NOO`,x` 0RD*0D&J38fB28Ho//NOOL\Nu/ O$oHoHoHo o$/(/(` NAHP/ NO?<Ho$?/"HzHzjNuHo*/ NO?<Ho4?/4HzHzDNuAPHP/ NOHoB/ NO?<HoL?/NHzHzNuA HP/ NOHoZ/ NOOh$_Nu/// O$oHoHoHo o"/(/(` NAHP/ NO?<Ho$?/"HzHzNuHo*/ NO?<Ho4?/4HzHznNuAPHP/ NOHoB/ NO?<HoL?/NHzHz?-@?-BHmHHzHzNuONu//?-$?-&?-(Hm.HzHz`NuONu//?- ?- ?-HmHzHz6NuONu//?-?-?-HmHzHz NuONuH:O$o>//NOO$d/NOXO/NO*XOf?<HzHz:NuTO/NO!&H0D?@V|</NOXO/p0 o\A// NO&/NOXO// 0/Cr2//NOv/ NO5/NO+O(0@r2// p0/x//NOvB'Hx0/C@r2//NO~OBon/Nr,of0D?@l`Boj`x>`|&R:/n0 GC@r2 /rA?pvgP0/vopcF0/lov&RHov0 GCHr2 /vAHp/ HzHz>NuO RD(RG<6FevRoj6/jl e`Ron(R0/nl eF`/NO(/NO5p0/l//NOb&H Of?<~HzHzxNuTO/ NO!$<s???/HzHzNux80@r2// /NOXO//NOvB'Hx/NOSXO//NO~/NO?@&RHo0 FGHr2AHp/ HzHz"NuHx/ R0(Hr2//-NOvONOxL\Nustostr--null addrUsing numeric var. where string expected var#%d kind=%c%c.H8O$oh(orffAHPHzHz4NuXO *sf*?*AHPHoNOHo HzHzNuO*f<n?/r?/r?/r/ HzHzNu&HfO gf/TP/lT *if /,/,HoXHzHzNuO *gHxHoT/ NO&O `HxHoT // NOvOOXLNustodbl--null addrUsing string var. where numeric expected(%d)./B-_// ?/ ` N6 -_\OfHzHz܄Nu0&Nu//?-X?-Z?-\/-bHzHzZNuONu//?->?-@?-B/-HHzHz0NuONu//?-$?-&?-(/-.HzHzNuONu//?-?-?-/-HzHzNuONu/ Jmpf,//NO$H XOf?<HzHzNuTO J$_NuHxNO$H XOf?<HzHzNuTO//NO%HXOf?<HzHz۬NuTOB B// NOR@r2XO/NO%HXOf?<HzHzpNuTO// /*NOJrPOf +JrBB`%mr j B+Jr j$_Nu/ Jmpf,//NO$H XOf?<HzHzNuTO J$_NuHxNO$H XOf?<HzHzNuTO//NO%HXOf?<HzHzڶNuTO/*NO!%H B//NOR@r2XO/NO%HPOf?<HzHzrNuTO// /*NOJrPOf +JrBB`%mr j B+Jr j $_NuH0&oJmpf / NOXO`F$mr` g$j f f/ NO0<XO` /* NO6/ HzHz\Nu0POL NuH0&oJmpf / NO!XO`b$mr` g$j f f`F/ NO!%H R&*pXOc(//*A*HPHmNOHmNOHxNOO j L NuToo many locks %s cnt=%luH0&oJmpf / NO"XO`l$mr` g$j f fAXHPNOHxNOPO/ NO"B &*XOf(//*ATHPHmNOHmNOHxNOOSpL Nucan't find a matching handle to unlockToo few locks %s cnt=%luH0&oJmpf / NO5XO`p fp`h$mr` g$j f fATHPNOHxNOPO&*f(//*AXHPHmNOHmNOHxNOO/ NO5SpXOL NuCan't find a matching ptr to unlockToo few locks %s cnt=%lu/ Jmpf://?/////NOl$H Of?< HzHzdNuTO J$_NuHxNO$H XOf?<HzHz8NuTO//?/////NOl%HOf?<HzHzNuTOB B//NOR@r2XO/NO%HXOf?<HzHzNuTO///*NOJrPOf +JrBB`%mr j B+Jr j$_Nu/ Jmpf?/ // NO_\O`HxNO$H XOf?<HzHzNNuTO?/ // NO_%H\Of / NOXO`rB B//NOR@r2XO/NO%HXOf?<HzHzNuTO///*NOJrPOf +JrBB`%mr j B+Jr j$_Nu/ Jmpf?/ // NOn\O`HxNO$H XOf?<HzHzxNuTO?/ // NOn%H\Of / NOXO`rB B//NOR@r2XO/NO%HXOf?<HzHzNuTO///*NOJrPOf +JrBB`%mr j B+Jr j$_NuH0&oJmpf / NOaXO`<$mr` g$j f f0<`/ NOa6/ HzHzNu0POL Nu/ / $o &j g/ NOXO&j g&rf+jr` R!j/ NOXO$_&_NuH0$o&ov`?/ NO\OgRC/ NO@XOe?/ NO\OL NuQOHW////?-NO o !oONuQOHW////?-NO o !oONuQOHW////?-NO o !oONuQOHW// // // // ?-NO o" !oONuQOHW////?-NO o !oONuQOHW////?-NO o !oONuQOHW////?-NO o !oONuQOHW////?-NO o !oONuQOHW////?-NO o !oONuQOHW////?-NO o !oONuQOHW////?-NO o !oONuQOHW////?-NO o !oONuQOHW////?-NO o !oONuQOHW////?-NO o !oONuQOHW////?-NO o !oONuQOHW////?-NO o !oONuQOHW// // // // ?-NO o" !oONuQOHW////?-NO o !oONuQOHW////?-NO o !oONuQOHWHzHzDNuBgHoNOHo ?<NOONu/ NOs$H?// NO\O?/ NO\O$_NuH:O&oFBoHW?</HxHx?/2?+?+HzHzrNu(HHo@/ NO$HJoHO(gAHPHzHzФNuXOB'B/ / NO/NO HzHz NuSOfHo<tNO/ NO9@ /?<HxHx?/.0+H?0+H?HzHz\Nu$HHo<6|<vֆAHP/HzHz&Nu+HOg><8B'//-NO'E R"m2 R3h R3h Rh  IBh Rp (  I((| (p0/ R/pЉ/NO&OB'/ NO\O mTOLNunewBmp/ NOs$H?-\HzHzNu// ?-\/ NO\O?/ NOO $_NuOHoHzHzNuHoHoHoNOHoNOHoNOOHoHoHoNO0/"oO f 0/og"?/?/?/?/NO?o?o POJ/fHWNOONuH:O$o@(oDA /P/hHoH?<NO \OgHoHoHo/ HzHz RNu/ HzHz Nu POd cAHP/ NOXO/HzHzNu$/HzHzZNu.B'/NOXO//NO'Hx/ /NO& G|0^@H1@8(60H@CO"gRhp0,A/H Gp0(PP/H Bo`p0,ѯv&o Gp0(ѯ $o z|`PxMMP`. gA00HH@g CfvR`RCR,e EfzR`RERFTmRo0/lmx G"G0)@r2//NOJ@POg?<HzHzNuTO?/J?/J/NO&/ NOO `?/J?/J/ NO&POOL\Nu@ bitmH:,o(/NO& XOo/<NOXO`. rHzHzNNurHzHzNu/NOXO*fA$HPHzHz@NuXO/NO!(H XOfA(HPHzHzNuXO&L$NA8.dv,G` RR gdg K,/ NOrЁXOcH/ NO5/NO-XO//NO3J@O g?<HzHzȚNuTO/NO!(HGhXOJf `r f ```ZB KA// NOJ@POg?<HzHz4NuTO LL\NuOut of memory trying to compress bitmap.Out of memory trying to compress bitmap.H8YO$o$//$NOr2XO/NO&H XOfA&HPHzHz֠NuXO/ NO!(H&LXO`|0Z@H./ NO K̐XOd|/ NO0FЈ& K*/ NO&H/ NO"// NO386Og?<HzHzNuTO/ NO!(H XOgJCgAHPHzHzNuXOGX fR fx`x`Rv:`RCEmJf4 K// NOJ@POg?<HzHzƔNuTO LXOLxNuOut of memoryOut of memory;o\//NO};@ZHzHzTNuXONu/ <` NXNOs$H?-/ HzHzNuPO$_NuQO;o\// NO};@Z|YHoHzHzNu/ NO/ NOO $_&_Nu/ NOs$H?-/ HzHzzNu\O$_Nu/ O//HzHzNu$H;o\//NO};@ZB-YHoHzHzNu/ NO/H///// Ho$HzHzNu/ NO5//,NO+O4$_Nu/ <` NX` N(NOs$H/-^/-b?-/ HzHz8NuO$_Nu/QOHW?</* `6`0*`(*` * `NJg p* `p`pL N^NuNVH0&nNJg?. / tNO\O`:?. / NO6 C\Ofp`"?/ NOQ\Ogp`?/ NO$H*\OL N^NuNVNJg /.NOXO` n0(N^NuNVN"N^NuNVNN^NuNV m, PNN^NuNV?< m,Hh N>N^NuNV/ `+R(?/+/+BBt%NOJOgAHP/ NOPO`AHP/ NOPOp`AHP/ NOJ@POf FHp8NOR@r2ցXO`X`P`P`P` T`X`RRD:ne L\xNuAttempt to reference column data without a current record for database=%sAttempt to read past end-of-file for database=%sAttempt to access deleted record for database=%s o0/hl JompNupNu o0/hl JompNupNu o2(&on 0h$onpNupNuQOBgNOHoHoBgNO /ONu/ / // NO$H/ NO"/ NO-ЯXO// NO3 OfA(HPHzHzNuXO/ NO!&H KXO$_&_NuOut of memory.p  o"hANu"o4)0/ B2)B@I iANuH0$o/*NO!&H/ BgNOE%@ /*NO"&* Of`4?</BgNOI&H POf`o%K5|BBjBj KL NuH0$o?* ?* NO~TO/NO\O/HzHzLNu XO/NOXO/NO!%H?* //"NO\O/HzHzNu5@?* //&NO\O/NO5@$5j$|y1BjBj&Bj(0*$S@5@*5j$,0*$HH/NOXO/NO!%H0*$HH/NOXO/NO!%HB*|Bj.5| 5|"vO`2?/ HzHzDNu&H7CB+ Bk7C|s BRC\Ojmx`Nv:`@??/ HzHzNuBB'???* ?* NO~TO/NO\O/NORCOjmRDj$mHj4?* ?* NO~TO/NO\O/NOPOL 8NuH8&o8/6/?/ HzHzNuJ\Og?/ HzHzNuJ\Og?/ HzHzDNu??/ HzHzBNu$H(R Og/ NOXO//"NOR@r2XO/NO$//&/NO -bO g4J/ f.?/ HzHz&NuJ\Og/ HzHzNuXOLNuH0&o8/6/?/ HzHzNuJ\Og?/ HzHzNuJ\Og?/ HzHzVNu$H *s \Ogx??/ HzHzHNu$HJPOf HxNO$XOHxHo"/NO& -bO g4J/f.?/ HzHz@NuJ\Og/ HzHzNuXOL Nu/ $o// / HzHzNuPO?/ NO;@?-` N$H?*` NO $_Nu/ $o// / HzHzJNuPO?/ NO;@?-` N$H?*` NO $_Nu/ $o// / HzHzNuPO?/ NO;@?-` N$H0* R@?` NO $_NuH QOB/??/ HzHzxNuJPOg ??/ HzHz\NuPO/NOXORCjm6*0R@@of:REM&jGPI0R@2@IH// / NO&>*<*6G0&jG0H(K0R@2*@IH// / NO&O jo,0*jHD@H//*HzHz.Nu%HPO`:v`*HxNOXO/NO!&H B+0H j!RCXO0*j@mSj6*j&n0S@5@&LNuH:QOv//4//4HzHzNuPO?//2NO;@?-` N$HBjBj&|` NS@5@.;j.$` NR&HPO` N8 DgDRCjoAHPNOpO `0S@?/ HzHzjNu(H9D| \O`5C og\|/ HzHzrNu XOf>/+NO!(H/ AHPHmNO/+NO"HmHzHzzNuO`(k~>-p0 mz 0\f|/ NOOJ@XOgBj|`hHxHxHo?/ NOP0/@OfBp0- mz 0\fZ?/ / HzHzNu0R@7@Vm` N` N60C ЀAJpO g0j./*NO䈰XObHx/*HzHzNu%HPO0R@r20*H j!8*6*Dot,j f0DHH/NOXO/NO!%HXO`"0DHH//HzHz(Nu%HPO6*`8*0DCDH jBRC:*EmRj;GRF/ NOO@XOeJ/g/ ` N@XOp0- mz 0\fRm` N";@ -bf/ HzHzNuXO`/ HzHzNuXOPOL\NuTrying to bind more db fields to grid than there are columns of the grid.The database '%s' linked to a bound grid cannot be openedH ?/NOs/NO\O?` N$H0/j&Jj&TOlBj&8*6SCj&l5C&|/ HzHzNuXOLNu/ $o// / HzHz۲NuPO?/ NO;@?-` N$H?-/ HzHz*Nu -bOg/ HzHz?j60*8S@60*:S@8HW?<NO\O`HW/ NOIIBTvPO` ?/ HzHzۜNu0(R@TRC\OjmGGBSv`S RCj$mMMSVSS6*40j82V@nHW?<NO\O`$>?j60*8S@80*:S@6HW?<NO\OPOL\8NuH:$o(?* NO~,H>* ?/NO&H|PO`8NOhR@??/ NO<?/ NO<?/ NOv:O`NJFfHzV?/ NOO 8??/ NOPONOd<?/ NO<??/ NORCOjmRFj$mpBj(0*j$5@*Jj*l5|*6* NOs/NO@@XOd,0R@?NOs/NO \Of0R@?/NO(H\O`8*$6*0*&DCo0D5@&Jj&lBj&0*j$n8 @d g`BB/ NOO `P gL0* R@?NOs/NO\O`6 g20* R@?NOs/NO/ NO?*,?**?*(?*&/ NOOL\NuH:Oj>/$oBLBP6/NOc@K//NOs/HzHzNuPO?NOs/NO\O?` 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i@ sA++sBsCsD iE iFsG//sHsIsJ iK iLsM,,sNsOsP iQ iRsS\\sTsUsV iW iXsY33sZs[s\ i] i^s_%%s`sasb ic id seJJsfsgsh ii ijsk44slsmsnso ip iqsrNNss n@t n@u n@vswsx iy iz n@{i|i}i~s,,ssssss i iiiiiiiiiiii isss i isiiiiiii isss i iCCsss i i s99sss i iRRs n@ n@ n@ n@ n@ n@ss i i n@iiiiiis::ssiiiiiiss i iNNsiiiiiii isss i i@@sss i is[[sss i isFFsss i is==sss i isNNsss i ibbsiiiiiiiiii iss s i i s iiiiiii44ss!!s''spps%%s s<<s##sEEs!!ss s!s"s#s$lls%s&s'i( i)s*s+s, i- i.LLs/i0i1i2i3i4i5i6 i7s8s9s: i; i<s=CCs>s?s@ iA iBjjsCiDiEiFiGiHiIiJ iKsLsMiNsOSSsPOOsQ<<sRiSsTjjsU>>sVEEsWDDsX]]sYsZs[||s\HHs]s^s_VVs`CCsaIIsb))scsd]]seHHsfsg]]shsiKKsjsk77slZZsmSSsn00so<<sp66sqsrKKssGGst88susv$$sw sx>>sy<<sz??s{DDs|s}LLs~ssssNNsmmsaasllsssccsffs sHHss[[s77ss''ss,,ssss44s55s sQQs,,s--sVVs**s sQQsJJs33sss##sss00s((ssOOsssffsIIsggss\\ssss55s..sNNssHHs||s%%ssss33sssddsccsss sOOsHHs""s++ss&&s!!ss ss,,ssssss i i??siiiiiii isss i iZZsiiiiiii isss i iaasss i is22sss i iGGsss i isPPsss i i s __s010100122223132010101145678910 NSBSystemLibNSLmain ischemiamainichmain extrasmainAuthorCincinnati Strokes was created by Michael Ward MD, MBA while he was an Emergency Medicine resident at the University of CincinnatiOK disclaimer DistributionThis program is meant to be freely distributed. You can either beam this to other individuals or email the program. We encourage the free distribution of this program!HandHeldDoc.comBVisit us at www.handhelddoc.com and let us know how we are doing!Help?Interested in helping with Cincinnati Stroke? Feel free to send your suggestions, ideas or comments to Michael Ward at info@handhelddoc.com NavigationpThere are multiple ways to navigate this program. Either use the drop down menus or the buttons at the bottom.ProgramThis program was developed by Michael Ward at the University of Cincinnati. This goal of this program is to provide information available at the click of a button.5menuemcreg0146160vThese materials are intended to provide assistance to the user as a reference tool. While every effort has been made tto ensure the accuracy of the recommendations made herein, these materials are not intended to be a substitute for `professional medical advice or treatment or the exercise of professional judgment in any given  ksituation. Rather, these materials are intended only for general informational purposes. They reflect the !best judgment of the editors And contributors as of the date of this publication and are subject to change. The content set forth in these "gmaterials should Not be construed as the sole basis For the user's own medical judgments or decisions.#10$jUnder no circumstances will Michael Ward, his affiliates or any of their respective directors, officers, %qmembers, employees or agents or otherwise any editor or contributor to these materials be responsible or liable &oto any user or other entity for any direct, compensatory, indirect, incidental, consequential (including lost 'eprofits or lost business opportunities), special, exemplary or punitive damages that result from or (frelate in any manner whatsoever to (1) use of these materials or reliance on the content thereof, or )q(2)errors, inaccuracies, omissions, defects, untimeliness, security breaches or any other failure to perform by *BMichael Ward, his affiliates or any editor or contributor hereto.+i,2972/tiamain0 scalesmain1238173438185381261738138381494405:3816;4829>ABCD2 Score (TIA)?1018@11A2Babcd2CAnticoagulation ResumptionDanticoagulationEBP Management (ICH)FbpmanagementichGBP Management (Ischemia)H bpmanagementIBrain Death ExamJ braindeathKCelsius <--> FahrenheitLtempconversionMCranial NervesNcranialnervesODVT Prophylaxis (ICH)PdvtmanagementQElevated ICP (ICH)RicpmanagementSElevated INR ManagementTinrUFischer Scale (SAH)VfischerWGlasgow Coma ScoreXGCSYGlasgow Outcome ScaleZGCOS[Heparin Induced ICH\ heparinich]Hounsfield Units^ hounsfield_Hunt Hess Classification (SAH)` hunthessaHypercoagulation Labsbhypercoagulationc ICH Scored ICHScoree ICH Volumef ICHvolumegImaging in Strokeh mritypesiKey History ElementsjhistorykKilograms <--> Poundsl w8conversionmLabs/Studies to ObtainnlabsoLikelihood of ICHp ichratesqMean Arterial PressurermapsModified Rankin ScoretmrsuNIH Stroke ScalevNIHwOutcomes (Ischemia)x cvaoutcomeyPhenytoin Correctionzserumphenytoin{Physiology Management (ICH)|physiologicmgmt}Prehospital Stroke Tools~cphssStroke MimicsmimicStroke Resources resourcesStroke SyndromesstrokesyndromesSubarachnoid HemorrhagesahmanagementtPA Dosing Calculator tpadosingtPA-Indications/ContratpaexclusionstPA Induced HemorrhagetpaichWFNS Scale (SAH)wfns Ischemia3809ICHTIAExtrasStroke Scales48384845484048394841484248434844BP Management1808Likelihood of HemorrhageOutcome PredictorsTable of Contents4419Main484648534849484748484850485148521841DVT Prophylaxis Elevated ICPPhysiology Management44284854486148584855485648574859486044094410486748624869486348644865486648684437 Resources443848764870487748714872487348744875511851194104489648974898489949004901Patient Not Eligible for tPA4099!Patient is NOT eligible for tPA:Although exact blood pressure ranges are not known at which to treat hypertension, a consensus exists to lower blood pressures >220/120 by 15% in the first day.4097Patient Eligible for tPAMPatient is eligible for tPA and either Systolic >185 or Diastolic >110mmHg:61.Labetolol 10-20 mg IV over 1-2 min, may repeat x 1-Or-2.Nitropaste 1-2 inches3.Nicardipine IV drip 5mg/hr, titrate up by 2.5mg/hr at 5-15 minute intervals (max dose of 15mg/hr), decrease by 3mg/hr when desired BP reachedN**If BP does not reach goal and remains >185/110mmHg, DO NOT Administer tPA.Patient Treated with tPAMonitor BP every 15 min during treatment, then for an additional 2 hours, then every 30 minutes for 6 hours, then hourly for the next 16 hours.,Systolic 180-230 or Diastolic 105-120mmHg:O1.Labetolol 10 mg IV over 1-2 min, may repeat every 10-20 minutes (max 300mg)72.Labetolol 10mg IV followed by infusion at 2-8mg/min)Systolic >230 or Diastolic 121-140mmHg:X3. Nicardipine infusion, 5mg/hr, titrate up by 2.5mg/hr every 5 minutes (max 15mg/hr).;If BP is NOT controlled, consider Nitroprusside infusion. Reference`Adams HP et al. Guidelines for Management of Adults With Ischemic Stroke. Stroke 2007, p. 1671.4806490249034904490549064907 LOC 1a General level of how alert the patient is. The investigator must choose a response if the pt is intubated or other communication barriers are present.LOC 1b'Ask patient the month and his/her age.LOC 1cXAsk patient open and close the eyes and then to grip and release the non-paretic hand. Best Gaze.Test best gaze with horizontal eye movements."Visual#VTest Visual Fields using confrontation, finger counting or visual threat, as needed.(QTest for Palsy by asking Patient to show teeth or raise eyebrows and close eyes.- Arm Testing.Extend the arm (palm down) 90 degrees (if sitting) or 45 degrees (if supine). Score Drift if the arm falls before 10 seconds.3nih28mNational Institutes of Neurological Disorders and Stroke. http://ninds.nih.gov Viewed on November 13, 2007.94807:4908;4909<4910=4911>4912?4913F Leg TestingGdHold the leg at 30 degrees (always done in supine). Score drift if the leg falls before 5 seconds.P Limb AtaxiaQrTest with eyes open. Do finger to nose and heel-shin on both sides. Score only if out of proportion to weakness.VSensory TestingWUse pinprick or noxious stimuli (obtunded/aphasic pt). Test as many body parts as needed to accurately check for sensory loss.\ Language]Use a picture to have the pt describe what is happening and have them name objects. Judge comprehension and language from their responses.b DysarthriacIf the pt is normal, have pt repeat the following: 'MAMA', 'TIP TOP', 'FIFTY FIFTY','THANKS','HUCKLEBERRY','BASEBALL PLAYER'.hExtinction/InattentioniMay be obtained in prior exam.z0:Alert{4017| 1:Arousable}2:Req. Stimulation~3:Unarousable/Reflex Only30:Both Correct4019 1:Correct2:None Correct4021 1:1 Correct0:Normal Gaze40231:Partial Gaze Palsy2:Forced Deviation0:No Visual Loss40251:Partial Hemianopia2:Complete Hemianopia3:Bilat. Hemianopia0:Nml sym mvmts40271:Minor paralysis2:Partial paralysis3:Paralysis of 1 side 0:No drift40291:Drift2:Some effort vs gravity3:No effort vs gravity4:No movement40:Amputee/joint fusion403140444046 0:Absent40481:Present in 1 limb2:Present in 2 limbs 0:Normal40501:Mild-Mod Sens. Loss2:Severe/Total Loss 0:No Aphasia40521:Mild-Mod Aphasia2:Severe Aphasia3:Mute0:No Dysarthria40541:Mild-Mod Dysarthria2:Severe Dysarthria0:Intubated/Unable0:No abnormality40561:Sensory inattention2:Profound hemi-inattention40684139491449154916491749184919616251140uAdams HP et al. Baseline NIH Stroke Scale score strongly predicts outcome after stroke. Neurology 53;1, July 1999.39874920492149224923492449253969.990981.1 mg39733975Inclusions for tPA1. Age: >=18 yo 2. Clinical Diagnosis of Stroke3. Onset <180 minutes`Adams HP et al. Guidelines for Management of Adults with Ischemic Stroke. Stroke 2007, p. 1674.4094492649274928492949304931-1.Current use of anticoagulants and INR >1.5,2.Use of Heparin (<48hrs) and PTT prolonged3.Hx of CVA in past 3 mos*4.Hx of serious head injury in past 3 mos:5.Major surgery, biopsy of organ or trauma in past 14days6.Hx of any previous ICH)7.Hx of intracranial CA, AVM or aneurysm 8.Hx of Seizure at onset of CVA,9.Hx of GI or urinary bleed in past 21 days10.Hx of MI in past 3 mos.211.Hx of pregnancy or parturition in past 30 days112.Hx of hereditary/acquired abnormal hemostasis"13.Lumbar puncture in past 7 days>14.Arterial puncture at non-compressible site in past 30 days4089$1.Rapidly improving neurological SxL2.Isolated mild neurological Sx or NIHSS <4 and normal speech/visual fields03.Presentation suggesting SAH despite normal CT 44.Pretreatment HTN: SBP >=185 mmHg or DBP >=110mmHg .5.Presumed septic embolus (stroke with fever) 6.Glucose <50 mg/dl 7.Platelets <100,000/mm 58.Clinical presentation suggesting aortic dissection:9.Head CT suggesting intracranial hemmorrhage of any type4091VHarwood-Nuss' Clinical Practice of Emergency Medicine Editor: Wolfson, AB. LWW 2005.47794932493349344935 4936!4937(If ICH Occurs)1.Obtain bleeding time 2.Consult Hematologist 3.If elev. PT/INR-give FFP, if fibrinogen low-give cryoprecipitate 250(mg/unit).SCincinnati Stroke Team, 2007. This pathway has not been prospectively validated./44800493814939249403494144942549438 ICH 0-3 Days94486:Patients with Intracerebral hemorrhage between days 0-3 post- ICH should have intermittent pneumatic compression devices to prevent venous thromboembolism.;4488< ICH >4 Days=For patients that have a documentation of bleeding, consideration for starting low molecular weight heparing or unfractionated heparin can start 3-4 days from onset.>ICH with DVT/PE?tPatients who have an ICH who develop a deep vein thrombosis should be considered for an inferior vena cava filter.DmBroderick J et al. Guidelines for Management of Spontaneous Intracerebral Hemorrhage. Stroke 2007, p. 2010.E4083F4944G4945H4946I4947J4948K4949NLife Threatening BleedingO4077P1.Hold WarfarinQr2.Administer Vitamin K1 10mg IV by slow IV push (consider diluting in 50cc saline or D5W to prevent anaphylaxis)R)3.Give prothrombin complex concentrate*S4.Repeat if necessaryTF*Recombinant Factor VIIa may be used as an alternative to prothrombinU4075V AdmissionW4079X!Serious Bleeding (Any Elev. INR)Y]3.Give fresh frozen plasma (FFP) or prothrombin complex concentrate depending on severity*Z)4.Repeat Vitamin K1 if necessary Q12 hrs[INR (supratherapeutic but <5)\1.Lower Warfarin dose]-OR-^(2.Follow INR if only minimally elevated_E3.Omit 1 or 2 doses And resume at lower dose when INR is therapeutic`,Home: patient can be followed as outpatientaINR 5-9; No Bleedingb_1.Omit next 1-2 warfarin doses, monitor INR and resume Warfarin at lower dose when therapeuticc92.Omit 1 warfarin dose And administer 1-2.5mg Vitamin K1dAdmit all high risk patients (elderly, higher INR, history of bleeding, stroke, CHF, cancer, renal insufficiency, anemia, hypertension)eINR 9-20; No Bleedingf%2.Administer 5-10mg oral Vitamin K1gB3.Monitor INR frequently and administer oral Vitamin K1 as neededh24.Resume Warfarin at lower dose when therapeuticiClose follow-up for low-risk patients. Admission or observation for high risk patients (elderly, higher INR, history of bleeding, stroke, CHF, cancer, renal insufficiency, anemia, hypertension)jINR >20; No Bleedingk,1.Omit next 1-2 warfarin doses, monitor INRlj2.Administer 10mg IV Vitamin K1 slowly (consider diluting in 50cc saline or D5W to prevent anaphylaxis)m3.Supplement with prothrombin complex concentrate, fresh frozen plasma or recombinant human factor VIIa depending upon severityrA1.University of Cincinnati: www.cpqe.com 2.Chest 2004; 126:204S;s4124t4950u4951v4952w4953x4954y4955mBroderick J et al. Guidelines for Management of Spontaneous Intracerebral Hemorrhage. Stroke 2007, p. 2012.4014495649574958495949604961'ICH Volume calculated by ABC/2 method.4000400140024003400540064007The Patient receives " points. 30 day mortality is 0%." point. 30 day mortality is 13%.# points. 30 day mortality is 26%.# points. 30 day mortality is 72%.# points. 30 day mortality is 97%.$ points. 30 day mortality is 100%.|Hemphill, JC et al. The ICH Score: A Simple, Reliable Grading Scale for Intracerebral Hemorrhage. Stroke 2001;32;891-897.42655121512251235124512551264271Patients with mechanical valves are high risk for recurrent venous thromboembolism and anticoagulation should resume 7-10 days after original intracerebral hemorrhage.42664272These patients are high risk for recurrent intracerebral hemorrhage and should be treated with antiplatelet agents for prevention of thromboembolic event.4470496249634964496549664967SBP >200, MAP >1504476SBP >200 or MAP >150{Consider aggressive reduction of BP with continuous intravenous medications and frequently monitor BP (every 5 minutes).4478SBP >180, MAP >130 (Elev ICP)=SBP >180 or MAP >130 and there is suspicion of elevated ICPConsider ICP monitor and reducing BP with intermittent or continuous intravenous infusion to keep CPP greater than 60-80mmHg.!SBP >180, MAP >130 (No Elev ICP)8SBP >180 or MAP >130 and no suspicion of elevated ICP.Consider modest reduction of BP (Target MAP of 160 or BP of 160/90) using intermittent or continous intravenous medications and frequently monitor BP (every 15 minutes).4243496849694970497149724973<30 min4261 30-60 min.5.75 60-120 min.375 >120 min.25100425250Give  to omg by slow IV infusion (max 5mg/min), not to exceed a total of 50 mg. Faster rates can produce hypotension.42584279497449754976497749784979 DiameterRound to the nearest 0.5cm42894291429342954298hKothari RU et al. The ABCs of Measuring Intracerebral Hemorrhage Volumes. Stroke. 1996;27:1304-1305.4463 4980!4981"4982#4983$4984%4985,oBroderick J et al. Guidelines for Management of Spontaneous Intracerebral Hemorrhage. Stroke 2007, p. 2008-9.-4473.4986/4987049881498924990349916Glucose744858bHyperglycemia (>140 mg/dL) during the first 24 hours of a stroke is a poor prognostic indicator.9 Blood sugars >185 mg/dL and possible >140 mg/dL should be managed with insulin. This applies to both ischemic strokes and intracerebral hemorrhages. :4491; Seizures<]Prophylactic seizure precautions should be made for patients with intracerebral hemorrhage,= particularly those with lobar hemorrhage. Choice of antiepileptics should include those that can be administered intravenously and>t orally (upon discharge). Treatment of clinical seizures is otherwise the same as any other hospitalized patient.? Temperature@XThere is no role for hypothermia in ICH. Hyperthermia or fever should be treated withA' antipyretics in patients with stroke.FpBroderick J et al. Guidelines for Management of Spontaneous Intracerebral Hemorrhage. Stroke 2007, p. 2009-10.G5140H5141I5142J5143K5144L5145P.2Q5147R5131S mg/dlT5134YCorrected PhenytoinZPhenytoin/(0.2*Albumin+0.1)[4555\5004]5005^5006_5007`5008a5009dCN Ie4553fCranial Nerve I-Olfactory:g%Sense of smell, usually not tested.h4551iCN IIjCranial Nerve II (Optic):kExamine visual acuity in each eye separately then test visual fields. Additionally, test the pupillary response in both eyes.lCN IIIm Cranial Nerve III (Oculomotor):ngInspect the eyes for ptosis, position and nystagmus. Test extraocular movements (EOM) by having theoo patient follow in an 'H' pattern. CN3 (Oculomotor) controls all extraocular muscles except for the superiorp: oblique and the lateral rectus. Also controls pupillaryq< constriction which can be induced through accomodation. rgUsually tested with CN4 and CN6. Oculomotor palsy can cause the patient's eye to appear 'Down n Out'sCN IVtCranial Nerve IV (Trochlear):ubControls the Superior Oblique (SO) extraocular muscle. The SO allows for looking down when thevW eye is adducted. The SO is also responsible for intorsion, depression and abductionw of the globe. Fourth nerve palsy can be identified if a patient has a characteristic head tilt or the patient reports a vertical diplopia.x\ However, this may be difficult to identify an isolated fourth nerve palsy if you are notyF a specialist in this area. Typically tested along with CN III, VI.zCN V{Cranial Nerve V (Trigeminal):|kThe Trigeminal nerve is responsible for sensation to the face. This can be tested with light touch, pain}m and temperature. Also responsible for the corneal reflex (along with CN7) and the muscles of mastication.~7 The temporalis and masseter can be tested by having| the patient clench their jaw and the pterygoids can be tested by having the patient open their mouth against resistance.CN VICranial Nerve VI (Abducens):}Responsible for abduction of the eye. Test by having the patient look laterally. Typically tested along with CN III, IV.CN VIICranial Nerve VII (Facial):Responsible for the motorG function involved in facial expression and taste to the anterior 2/3d of the tongue. This can be tested by having the patient smile, showing their teeth, raising theirB eyebrows, closing their eyes tightly, puffing out their cheeks.* There should be no noticeable asymmetry.CN VIII(Cranial Nerve VIII (Vestibulocochlear):Responsible for transmittingH sound and equilibrium to the inner ear. Test CN8 by testing hearing,` balance, doing Weber's (tuning fork on top of the skull to detect sensorineural hearing loss)I and Rinne's test (tuning fork placed on the mastoid process to detect conductive hearing loss.CN IX%Cranial Nerve IX (Glossopharyngeal):dHas a number of functions, most notably responsible for taste to the posterior 1/3 of the tongue,p also provides motor innervation to the stylopharyngeus muscle. Can be tested by the gag reflex. Frequently htested with CN X and the two are assessed by asking the patient to swallow and to speak (listening forF hoarseness and phonation) and having the patient say 'KA' and 'GO'.CN XCranial Nerve X (Vagus):[Supplies parasympathetic fibers to many organs and controls a large number of muscles in the mouth/neck. Frequently tested with CN IX and the two are assessed by asking the patient to swallow and to speak (listening forCN XICranial Nerve XI (Accessory):H function of the muscles in the neck including the sternocleidomastoid> and the trapezius. Assess this cranial nerve by having theT patient shrug their shoulder and turn their head to each side against resistance.CN XII!Cranial Nerve XII (Hypoglossal):Responsible for theS motor functions of the tongue. Assess CN12 by listening to the patient speak andI inspect the tongue for fasiculations. Have the patient protrude theirP tongue and it should be midline. If it deviates to one side, it will deviate to the affected side.  ReferencesdClinicalExam.com http://www.clinicalexam.com/pda/n_cranial_nerves_exam.htm Viewed on Nov. 8, 2007.RWikipedia http://en.wikipedia.org/wiki/Cranial_nerve_exam Viewed on Nov. 8, 2007.LeMedicine http://www.emedicine.com/oph/topic697.htm Viewed on Nov. 8, 2007.BSee references within the text by clicking on the drop down menu41105010501150125013501450154Labs/Diagnostic Tests to Obtain in Suspected StrokeAll Patients: Noncontrast Head CT or MRI Recent Events Blood glucose Renal panel/electrolytes ECG Cardiac markers CBC (including platelets) PT/PTT/INR Oxygen SaturationSelected Patients: Liver function tests Toxicology screen Blood Alcohol level ABG (if suspect hypoxia) Chest Xray, Lumbar Puncture (if suspect subarachnoid) EEG (if suspect seizures)4111`Adams HP et al. Guidelines for Management of Adults With Ischemic Stroke. Stroke 2007, p. 1665.501650175018501950205021Spontaneous: 43988 To Speech: 3 To Pain: 2None: 1 Oriented: 53990 Confused: 4Inappropriate Words: 3Nonspecific Sounds: 2Follows Commands: 639926Localizes Pain: 5Withdraws to Pain: 4Abnormal Flexion: 3Abnormal Extension: 2GCS is .502250235024502550265027-Key Historical Elements for Stroke Patients:1.Onset of Symptoms2.Recent Events a.Stroke b.Myocardial Infarction c.Trauma d.Surgery e.Bleeding3.Comorbidities a.Hypertension b.Diabetes4.Medications a.Anticoagulants b.Insulin  c.Antihypertensives 4106`Adams HP et al. Guidelines for Management of Adults With Ischemic Stroke. Stroke 2007, p. 1660.4501502850295030503150325033 Definition QA Hounsfield unit is a measure of radiodensity seen on computed tomography (CT)%}World Wide Web: http://www.medcyclopaedia.com/library/topics/volume_iii_1/h/hounsfield_unit.aspx Viewed on November 7,2007.&5052'5053(5054)5055*5056+5057/16290xxx11633216317MAP = SBP*(1/3) + DBP*(2/3)8411995064:5065;5066<5067=5068>5069AComplicated MigraineB4120C5History of similar events, preceding aura, headache.D4115EConversion DisorderFdLack of cranial nerve findings, neurological findings in a nonvascular pattern, inconsistent exam.GHypertensive EncephalopathyH?Headache, delirium, significant hypertension, cerebral edema.I HypoglycemiaJKHistory of diabetes, low serum glucose, decreased level of consciousness.KDHistory of seizures, witnessed seizure activity, postictal period.P`Adams HP et al. Guidelines for Management of Adults With Ischemic Stroke. Stroke 2007, p. 1663.Q4547R5082S5083T5084U5085V5086W5087ZT1 Weighted Images[4545\T1 Weighted Images:]WCause white matter to appear white and gray matter to appear gray, CSF appears black.^4543_T2 Weighted Images`T2 Weighted Images:a+Reverses what is seen in T1, brain tissuebA is dark and CSF is white. Can be converted to a FLAIR sequence.cFLAIRdFLAIR:e:Converted from a T2 series of images. Free water is darkfH and edematous is bright. This is the most sensitive way of evaluatingg8 for demyelinating diseases such as multiple sclerosis.hPerfusion Weighted Imagingi"Perfusion Weighted Imaging (PWI):jInvolves injecting contrastk< and a series of ultrafast MRI images to follow contrast inl the brain. PWI allowsm+ for assessment of cerebral blood flow andn blood volume in specifico regions of the brain.pDiffusion Weighted Imagingq"Diffusion Weighted Imaging (DWI):r"DWI measures the amount of waters, diffusion in tissues. In acute infarction,t& water diffusion is impaired. is theu' most sensitive for detecting cerebralv% infarction and can detect ischemicw< areas as well as infracted areas within minutes of onset.xNoncontrast Head CTy0Noncontrast Head CT: Uses ionizing radiation toz collect images. Can detect{8 acute infarction as soon as 4-6 hours following onset.| Magnetic Resonance Spectroscopy}'Magnetic Resonance Spectroscopy (MRS):~#Allows for the measurement of pH,& lactate and ATP to distinguish those areas of the brain which5 demonstrate salvageable neurons (ischemic penumbra)' versus those that have already died.Magnetic Resonance Angiography Magnetic Resonance Angiography: Used to visualize the arteries: of the head and neck looking for aneurysm and stenosis. The Internet Stroke Center: http://www.strokecenter.org/education/ais_imaging_tech/newmri-tech.htm Viewed on November 8, 2007.v Wikipedia: http://en.wikipedia.org/wiki/Magnetic_resonance_imaging#Specialized_MRI_scans Viewed on November 8, 2007.5094509550965097509850994498510051015102510351045105JFERNE: Foundation for Education and Research in Neurological Emergencies.www.ferne.orgAThe Internet Stroke Center at Washington University in St. Louiswww.strokecenter.org?NINDS: National Institute of Neurological Disorders and Strokewww.ninds.nih.gov4496510651075108510951105111 Fahrenheit1915321908Celsius F1919 CTemperature ConversionCF = (9/5*C)+32 C= (F-32)*5/9. 38C=100.4F 39C=102.2F 40C=104F511251135114511551165117 Kilogram19002.21885Pound lbs1904 kgWeight Conversion1 Kilogram = 2.2 * PoundsuThe strong reputations of our academic research constituency have helped to make the past year extremely productive in both our educational and research missions. At the end of 2004 EMCREG will have held its 13th educational satellite symposia over the past six years. The success of these events has raised EMCREGs reputation as an educational force to a level wherein our presence at annual scientific meetings has become an expectation of the emergency physician community. A notable change to the groups focus has been the inclusion of neurovascular emergencies to our focus. With the recent advancements in the diagnosis and treatment of these conditions, combined with the University of Cincinnatis reputation and strength in this field, it was a natural progression met with enthusiasm by both our constituents and our audiences. Our educational outreach has been further extended with an increasing number of professional quality educational monographs and hot-topics CME publications. The dramatic increase in emergency cardiovascular and neurovascular research and advancements has opened the door to a floodgate of educational opportunities fueled by a proportional increase in physician interest to keep current. Each educational piece we produce is delivered to the entire constituency of the American College of Emergency Physicians which averages 24,000 emergency physician members. In an effort to broaden our education impact, EMCREG is considering extending its outreach to the European emergency medicine community =and the nursing legions of the Emergency Nurses Association. An important mission of EMCREG has also been promoting the collaboration with other specialties in the arenas of both academic research and clinical practice. EMCREG has developed strong relationships with companion thought-leaders in both cardiology and neurology. These collaboration have involved collaborations on educational symposia, quality assurance initiatives, clinical research endeavors and clinical practice overall. These collaborations have done much to promote the reputation of EMCREG and the field of emergency medicine overall. Over the coming we year we hope to further strengthen our presence with the development of community-endorsed diagnostic and treatment pathways and clinical algorithms, and to finalize our current efforts to standardize the reporting guidelines for acute coronary syndrome }within the field of emergency medicine. We are proud of our accomplishments over a relatively short period of time and have 2every intention of living up to our core values: %Investigate | Educate | Collaborate.4823splash3957499249934994499549964997281828202844284128372838 2836 ABCD2 Score ^ points and they are LOW risk for Stroke: 1.0% at 2 days, 1.2% at 7 days, 3.1% at 90 days. ^ point And they are LOW risk For Stroke: 1.0% at 2 days, 1.2% at 7 days, 3.1% at 90 days. l points and the patient is at MODERATE risk For Stroke: 4.1% at 2 days, 5.9% at 7 days, 9.8% at 90 days.j points and the patient is at HIGH risk for Stroke: 8.1% at 2 days, 11.7% at 7 days, 17.8% at 90 days. abcd2commJohnston SC et al. Validation and refinement of scores to predict very early stroke risk after transient ischaemic attack. Lancet. 2007 Jan 27;369(9558):283-92.3964396349984999500050015002500328152There is much debate in the Stroke/TIA literature regarding the ability of clinicians to risk stratify patients For developing subsequent CVA  after suffering a TIA. High-risk patients should certainly be hospitalized For observation, expedited diagnostic work-up and rapid access to therapeutic !]interventions (tPA) should a stroke occur. Low to moderate risk patients might necessitate "]hospitalization If expedited work-ups cannot be arranged within 24-48 hours with guaranteed #eneurologist follow-up. The ABCD Risk Score Is a unified risk score comprised of various components $`of previous risk scores described in the TIA literature and has been validated and shown to be %imost predictive of 48 hour risk of CVA following a TIA. It can be used by clinicians to identify higher &2risk patients to facilitate disposition planning.'1. Johnston SC et al. Validation And refinement of scores to predict very early stroke risk after transient ischaemic attack. Lancet 2007; 369:283-92.(m2. Hankey GJ. The ABCD, California, And unified ABCD risk scores predicted stroke within 2, 7, And 90 days )after TIA. EBM 2007; 12:88.*39601 Contributor2HDr. Ben Bassin is a Resident Physician at the University of Cincinnati.34175450405504165042750438504495045@ Face ExamA,Have the patient smile or show their teeth.FNormal Face ExamG0Patient moves both sides of their face equally.LAbnormal Face ExamM-One side does not move as well as the other.R Arm ExamS]Have the patient extend their arms in front of them and count to 10 with their eyes closed.XNormal Arm ExamY4Both arms move the same or both do not move at all.^Abnormal Arm Exam_&One arm does not move or drifts down.d Speech ExameKHave the patient repeat a phrase such as 'The sky is blue in Cincinnati'.jNormal Speech Examk5The patient says the correct words without slurring.llaphssqAbnormal Speech ExamrOThe patient is unable to speach, slurs the words or says the incorrect words.{4158|4159}4160~CPHSS-Are you sure the patient is having a stroke?Assessment by prehospital care provider has sensitivity and specificity of 58 and 88%, respectively the patient is having a stroke.Assessment by prehospital care provider has sensitivity and specificity of 27 and 96%, respectively the patient is having a stroke.Assessment by prehospital care provider has sensitivity and specificity of 13 and 98%, respectively the patient is having a stroke.4524503450355036503750385039555635142Hunt WHR. Surgical risk as related to time of intervention in the repair of intracranial aneurysms. J Neurosurg 28 (1): 14-20. 1968.4195504650475048504950505051DHave the Pt. smile/grimace and evaluate for any droop or asymmetry. Grip Exam:Evaluate for normality, weak unilateral grip or no grip.SHave patient extend both arms and evaluate for drift or if the arm falls rapidly.421042154217421942214223LAPSS;The patient does not meet the LA Prehospital Stroke ScreenAssessment by prehospital care provider has sensitivity and specificity of 91 and 97%, respectively, that the patient is having a stroke.421342144216421842204222OKidwell CS et al. Identifying stroke in the field. Stroke 2000 Jan;31(1):71-64308505850595060506150625063APatient can perform their normal activities without disability.Slight Disability\Patient can care for themselves but is not able to perform every activity prior to stroke.Moderate DisabilityGPatient can walk without assistance but otherwise requires some help.Mod/Severe Disability>Patient cannot walk nor can they attend to own bodily needs.Severe DisabilityOPatient requires constant nursing attention and is incontinent and bedridden.cRankin J. Cerebral vascular accidents in patients over the age of 60. Scot Med J. 1957;2:200-215.5154517151725173517451755176727336 Report of World Federation of Neurological Surgeons committee on a universal subarachnoid hemorrhage grading scale.J Neurosurg 68:985-986, 1988. 523552295230523152325233523451.Coma with Temperature > 36.5C, Systolic BP >90mmHg2.Absence of Motor Responses" *Painful stimuli above clavicles( *Cold water calorics (CNIII, VI, VIII)q3.Absence of pupillary responses to light, pupils round or oval at midposition and dilated to 4-6mm (CNII & III)&4.Absent corneal reflexes (CNV & VII)!5.Absent gag reflex (CNXI & XII)=6.Absent cough in response to tracheal suctioning (CNIX & X)$7.Absence of sucking/rooting reflexF8.Apnea with PaCO2 of 60mmHg or 20mmHg above baseline (COPD patients)"Interval between two evaluations-*Term to 2mo: 48 hrs *>2m/o-1yo: 24 hrs!*1-18yo: 12 hrs"*>=18 yo: Interval is optional#Confirmatory Tests:$m*Term to 2mo: 2 confirmatory tests (EEG, Cerebral Angiography, Transcranial Dopplers, Cerebral Scintigraphy)% *>2m/o-1yo: 1 confirmatory test&*>1 yo: optional'5238.MWijdicks, EFM. The Diagnosis of Brain Death. NEJM 2001; 344 (16) 1215-1221./5188052031520425205352064520755208<Additional Labs=DConsider in pediatric patients or patients with veinous thrombosis.BkRahemtullah A, et al. Hypercoagulation Testing in Ischemic Stroke. Arch Pathol Lab Med. 2007;131:890901.C5228D5213E5214F5215G5216H5217I5218LAICA-Lat. Pontine SyndromeM5220NOcclusion of the long branches of the Basilar artery, the Anterior Inferior Cerebellar Artery (AICA) result in Marie-Foix Syndrome (or Lateral Pontine Syndrome) and the following findings:OT1.Contralateral weakness of the upper and lower extremities (Corticospinal tracts)PP2.Contralateral hemisensory loss of pain and temperature (Spinothalamic tract)Q=3.Ipsilateral ataxia of the arm and leg (Cerebellar tracts)R5224SASA-Dejerine SyndromeTkDejerine Syndrome or Medial Medullary Syndrome is caused by occlusion of the Basilar artery, anteromedialU? artery of the Vertebral artery or the anteromedial artery ofVF the Anterior Spinal Artery (ASA). It Is characterized by the triadWE of ipsilateral hypoglossal (CN12) palsy, contralateral hemiparesisX^ (Upper and lower extremity), and contralateral sensory loss (vibration And proprioception).YBasilar-Ataxic HemiparesisZAtaxic Hemiparesis is caused by occlusion of the small penetrating arteries of the Middle Cerebral Artery (MCA) and the Basilar artery[} affecting the posterior limb of the external capsule and the basis pontis of the pons. Occlusion produces the following:\I1.Contralateral weakness of the upper and lower extremities (Leg > Arm)] 2.Ataxia of the arm and the leg^Basilar-Anton Syndrome_WAnton Syndrome or Cortical Blindness is caused by bilateral Posterior Cerebral Artery`D (PCA) and Basilar artery tip occlusion of the bilateral occipitalaJ lobes. This causes bilateral visual loss with a denial of the blindnessb* and can result in visual hallucinations.cBasilar-Dejerine Syndromed^Dejerine Syndrome or Medial Medullary Syndrome is caused by occlusion of the Basilar artery,eI anteromedial artery of the Vertebral artery or the anteromedial arteryf of the Anterior Spinal Artery (ASA). It is characterized by the triad of ipsilateral hypoglossal (CN12) palsy, contralateral hemiparesisg^ (Upper and lower extremity), and contralateral sensory loss (vibration and proprioception).hBasilar-Foville SyndromeiLFoville Syndrome or Inferior medial pontine syndrome is caused by a lesionj in the dorsal aspect of thek8 Pons which is a result of occlusion of the paramedianl[ and short circumferential branches of the Basilar artery. Foville syndrome results in:mT1.Contralateral weakness of the upper And lower extremities (Corticospinal tracts)n12.Ipsilateral lateral rectus (CNVI) palsy whicho= produces diplopia when the patient looks toward the lesionp73.Ipsilateral facial paresis due to CNVII involvementqBasilar-Locked InrLOcclusion of the Basilar artery affects the bilateral pons and results in:sH1.Bilateral weakness of the Upper and lower extremities (Quadriplegia)t92.Bilateral weakness of the face (corticobulbar tracts)u3.Lateral gaze weakness (CN6)v%4.Dysarthria (corticobulbar tracts)w!Notes About Locked-In Syndrome:x?1.Reticular Formation is spared so the patient is fully awakey=2.Quadriplegia is due to bilateral corticospinal involvementz@3.Aphonia (loss of speech) is due to corticobulbar involvement{E4.Periodic impairment of horizontal gaze due to involvement of CNVI|Basilar-Marie Foix}MOcclusion of the long branches of the Basilar artery, the Anterior Inferior~t Cerebellar Artery (AICA) result in Marie-Foix Syndrome (or Lateral Pontine Syndrome) and the following findings: Basilar-Millard-Gubler SyndromeOOcclusion of the paramedian and short circumferential branches of the Basilarn artery, at the Basis Pontis in the Pons as well as the fascicles of CNVI and CNVII produces the following:b1.Contralateral hemiplegia of the upper and lower extremities due to pyramidal tract involvementm2.Ipsilateral lateral rectus (CNVI) palsy which produces diplopia when the patient looks toward the lesionBasilar-Raymond SyndromeOcclusion of the paramedian branches of the Basilar artery, at the Ventral Median Pons causes Raymond Syndrome and the following findings:d1.Ipsilateral lateral gaze weakness (Ipsiplateral lateral rectus paresis due to CNVI involvement)g2.Contralateral hemiplegia of the upper and lower extremities sparing the face (corticospinal tracts) MCA-CompleteIComplete Middle Cerebral Artery (MCA) occlusion produces the following:Contralateral Findings:\ 1.Weakness of the upper and lower extremities as well as the lower face (Face, arm > leg)82.Hemisensory loss of the upper and lower extremities.3.Sensory loss of the face(4.Hemineglect (non-dominant hemisphere)5.Lateral Gaze Neglect-6. Visual Field Defect-homonymous hemianopiaIpsilateral Findings:1.Gaze Preference Neither:5 1.Expressive Aphasia (Dominant hemisphere-Broca's)62.Receptive Aphasia (dominant hemisphere-Wernicke's) MCA-InferiorRInferior Division Middle Cerebral Artery (MCA) occlusion produces the following:-1. Visual Field Defect-homonymous hemianopia.2.Visual field defect-upper quadrant anopsiaW3.Constructional Apraxia-inability to draw 2D or 3D objects (non-dominant hemisphere)+4. Receptive aphasia (dominant hemisphere) MCA-SuperiorRSuperior Division Middle Cerebral Artery (MCA) occlusion produces the following:K1.Weakness of the upper and lower extremities as well as the lower face. 45. Expressive Aphasia (Dominant hemisphere-Broca's)MCA-Gerstmann SyndromeGerstmann Syndrome caused by Middle Cerebral Artery (MCA) occlusion in the cerebral hemisphere in the dominant parietal lobe produces the following:$1.Acalculia-inability to calculate2.Agraphia-inability to write3.Right/Left confusion14.Finger Agnosia-inability to recognize fingers)5.Ideomotor Apraxia-inability to imitateMCA-Ataxic HemiparesisPAtaxic Hemiparesis is caused by occlusion of the small penetrating arteries of the Middle Cerebral Artery (MCA) and the Basilar artery affecting the posterior limb of the external capsule and the basis pontis of the pons. Occlusion produces the following:PCA-Alexia without AgraphiagOcclusion of the Posterior Cerebral Artery (PCA) at the left occipital region and the splenium of theJ corpus callosum produces Alexia (inability to comprehend written words)h and contralateral homonymous hemianopia (visual field loss on the right or left halves of both eyes).PCA-Anton Syndrome]Anton Syndrome or Cortical Blindness is caused by bilateral Posterior Cerebral Artery (PCA) and Basilar artery tip occlusion of the bilateral occipital lobes. This causes bilateral visual loss with a denial of the blindness and can result in visual hallucinations.PCA-Balint SyndromeBilateral Posterior Cerebral Artery (PCA) occlusion and top of the Basilar artery occlusion produces Balint Syndrome which presents with the following Bilateral symptoms:61.Loss of voluntary eye movements (but not reflexes)/2.Optic Ataxia-poor optical/motor coordinationO3.Asimultagnosia-inability to recognize multiple elements in a visual objectsPCA-Thalamic Pain SyndromeIPosterior Cerebral Artery (PCA) occlusion of the branches that feed the} thalamus produce Dejerine-Roussy syndrome or Thalamic Pain Syndrome. This produces the following contralateral symptoms:&1.Hemisensory loss of all modalities2.Hemi-body painPCA-Weber SyndromePosterior Cerebral Artery (PCA) occlusion of the branches that feed the midbrain produce Weber syndrome. This produces the following symptoms:41.Contralateral Upper and lower extremity weakness 2.Ipsilateral lateral eye gazePCA-Unilateral OccipitaleUnilateral Occipital occlusion caused by infarction of the Posterior Cerebral Artery (PCA) producesd contralateral homonymous hemianopia (visual field loss on the right or left halves of both eyes).PICA-Wallenberg SyndromeOcclusion of the distal branches and the Superior Lateral Medullary artery and occasionally the Posterior Inferior Cerebellar artery (PICA) produce Wallenberg syndrome. The following symptoms occur: 1.HiccupsP2.Contralateral hemisensory loss of pain and temperature (spinothalamic tract)I1.Sensory loss to the face (pain & temperature) from the 5th CN nucleus#2.Facial pain-from the CN5 nucleus,3.Ataxia of the arm & leg (restiform body)4.Ataxic gait(restiform body)'5.Nausea/Vomiting (Vestibular nucleus)"6. Nystagmus (Vestibular nucleus)7.Vertigo (Nucleus ambiguus)!8. Hoarseness (Nucleus ambiguus) 9.Dysphagia (Nucleus ambiguus)-10.Horner Syndrome (Descending sympathetics)Vertebral-Dejerine Syndrome anteromedial artery of the Vertebral artery or the anteromedial artery of the Anterior Spinal Artery (ASA). It is characterized by the triad of ipsilateral hypoglossal (CN12) palsy, contralateral hemiparesis (Upper and lower extremity), and contralateral sensory loss (vibration and proprioception).@Stroke Center: www.strokecenter.org Viewed on December 12, 20075242525752585259526052615262[Krawczyk, J et al. Subarachnoid Hemorrhage. www.emedicine.com Accessed on January 8, 2008.5267528252835284528552865287bJennett B et al. Assessment of outcome after severe brain damage. Lancet 1975 Mar 1;1(7905):480-4Vegetative State3The patient exhibits no obvious cortical function.HThe patient depends upon others daily for physical or emotional needs.Mod. DisabilityQThe patient is able to function independently but has a disability i.e. ataxia. Good Recovery `The patient is able to resume normal activities even if there are minor neurological deficits.&             !$  &85#"C#1L79:$FUVU     U !"#$%k&'()*+,-./01a234567+e89:;<=g>?@ABC\DEFGHIsJKLMNOiPQRSTU_VWXYZ[Y\]^_`au|bcdefgvhijklmznopqrs`tuvwxyoxz{|}~y(  k]W[\#]_acjgcs<s"tvzxZ"]apjeb 2 luw{|x=EKLMSTNQURHGOW]i\c]!"345678;mnopqrs=cSTUVWXDA]^_`abdlyz t&<D >$ Enter Copyright 2008 HandHeldDoc.com v1.0 #Cincinnati Stroke  Tools for the Acute Management >!of Stroke >? >42sponsored by: ,BXnCinci Stroke Disclaimer ~P~  0 M; IF HQ T\ Eg Sr  ~.^ Main'ABCD2 Score (TIA)Anticoagulation ResumptionBP Management (ICH)BP Management (Ischemia)Brain Death ExamCelsius <--> FahrenheitCranial NervesDVT Prophylaxis (ICH)Elevated INR ManagementElevated ICP (ICH)Fischer Scale (SAH)Glasgow Coma ScoreGlasgow Outcome ScaleHeparin Induced ICHHounsfield UnitsHunt Hess Classification (SAH)Hypercoagulation LabsICH ScoreICH VolumeImaging in StrokeKey History ElementsKilograms <--> PoundsLabs/Studies to ObtainLikelihood of ICHMean Arterial PressureModified Rankin ScoreNIH Stroke ScaleOutcomes (Ischemia)Phenytoin CorrectionPhysiology Management (ICH)Prehospital Stroke ToolsStroke MimicsStroke ResourcesStroke SyndromesSubarachnoid HemorrhagetPA Dosing CalculatortPA-Indications/ContratPA Induced HemorrhageWFNS Scale (SAH) 0 M; IF H5Q T\ Eg Sr ?\  Topic Jump:LOBTable of ContentsIschemiaICHTIAExtrasStroke Scales  "8h IschemiaBP ManagementLikelihood of HemorrhageNIH Stroke ScaleOutcome PredictorsStroke SyndromestPA-Indications/ContratPA Dosing CalculatortPA Induced Hemorrhage 0 M; IF HQ T\ Eg Sr C?\  Topic Jump:DLOBTable of ContentsIschemiaICHTIAExtrasStroke ScalesCD  "8N~ ICH1 Anticoagulation ResumptionBP Management (ICH)DVT ProphylaxisElevated ICPElevated INR ManagementHeparin Induced ICHICH ScoreICH VolumeNIH Stroke ScalePhysiology Management 0 M; IF HQ T\ Eg Sr L?\  Topic Jump:MLOBTable of ContentsIschemiaICHTIAExtrasStroke ScalesLM7 ,BXn :TIA9ABCD2 Score (TIA)  0 M; IF HQ T\ Eg Sr :?\  Topic Jump:;LOBTable of ContentsIschemiaICHTIAExtrasStroke Scales:; :Pf| ExtrasUBrain Death ExamCelsius <--> FahrenheitCranial NervesGlasgow Coma ScoreHounsfield UnitsHypercoagulation LabsImaging in StrokeKey History ElementsKilograms <--> PoundsLabs/Studies to ObtainMean Arterial PressurePhenytoin CorrectionResourcesStroke MimicsStroke SyndromesSubarachnoid Hemorrhage 0 M; IF HQ T\ Eg Sr V?\  Topic Jump:WLOBTable of ContentsIschemiaICHTIAExtrasStroke ScalesVW *@VZ Scales 0 M; I F H Q T \ E g S r  ABCD2 Score (TIA)Fischer Scale (SAH)Glasgow Coma ScaleGlasgow Outcome ScaleHunt Hess Classification (SAH)Modified Rankin ScoreNIH Stroke ScalePrehospital Stroke ToolsWFNS Scale (SAH)?\  Topic Jump:LOBTable of ContentsIschemiaICHTIAExtrasStroke ScalesU  2BP Management-aP,a  Select!Patient Not Eligible for tPAPatient Eligible for tPAPatient Treated with tPASelect Situation: 0 M!; I"F H#Q T$\ E%g S k* @Rn 8   $>Z  x| 04Pl  ,H 2H^tNIHSS!+ LOC-1a:4 f SelectA Y,0:Alert1:Arousable2:Req. Stimulation3:Unarousable/Reflex Only/+ LOC-1b:4.f SelectA.Y!0:Both Correct1:1 Correct2:None Correct=+ LOC-1c:4<f SelectA<Y!0:Both Correct1:1 Correct2:None CorrectK+ Gaze:4Jf SelectAJY!0:Normal Gaze1:Partial Gaze Palsy2:Forced DeviationY+ Visual:4Xf SelectAXY,0:No Visual Loss1:Partial Hemianopia2:Complete Hemianopia3:Bilat. Hemianopiag+ Palsy:4ff SelectAfY,0:Nml sym mvmts1:Minor paralysis2:Partial paralysis3:Paralysis of 1 sideu+ L Arm:4tf SelectA]YB0:No drift1:Drift2:Some effort vs gravity3:No effort vs gravity4:No movement0:Amputee/joint fusion+ R Arm:4f SelectA]YB0:No drift1:Drift2:Some effort vs gravity3:No effort vs gravity4:No movement0:Amputee/joint fusion{$ Next -> Evaluate the Patient Below:&0 M'; I(F H)Q T*\ E+g S ) :Nj &*Fb ">  VZv 8  dh$:Pf|NIHSS-2/ L Leg:3f Select@YB0:No drift1:Drift2:Some effort vs gravity3:No effort vs gravity4:No movement0:Amputee/joint fusion,/ R Leg:3,f Select@,YB0:No drift1:Drift2:Some effort vs gravity3:No effort vs gravity4:No movement0:Amputee/joint fusion:/ Ataxia:3:f Select@:Y,0:Absent1:Present in 1 limb2:Present in 2 limbs0:Amputee/joint fusionH/ Sensory:3Hf Select@HY!0:Normal1:Mild-Mod Sens. Loss2:Severe/Total LossV/ Lang.:3Vf Select@VY,0:No Aphasia1:Mild-Mod Aphasia2:Severe Aphasia3:Muted/ Dysarth:3df Select@dY,0:No Dysarthria1:Mild-Mod Dysarthria2:Severe Dysarthria0:Intubated/Unabler/ Extinct:3rf Select@rY!0:No abnormality1:Sensory inattention2:Profound hemi-inattentionz$ Calc$ <- Back[@PNIH Stroke Scale: Continue Responses Below:,0 M-; I.F H/Q T0\ E1g S a (:L`t(<Nr2HIschemic Outcomes-1NIHSS.71% Good or Excellent/@0-30N4-61 \7-102 j11-1537@95% good or excellent47N88% good or excellent57\78% good or excellent67j56% good or excellent77x42% good or excellent8 x16-229 >22:718% good or excellent*Prognosis at 3 Months for Untreated,*Stroke (by NIHSS)20 M3; I4F H5Q T6\ E7g S+ e 0X8P&<Rh~tPA Dosing (Stroke)EBPq$ CalcJTRPJgRPwx$ Clear> tPA IndicationsFZ tPA ContraindicationsiRemaining 60 Min:[kgVFirst 1 Minute:yAlso See:1tPA Dosing (Stroke): 0.9 mg/kg, (max<of 90 mg) 10% given over 1 min, thenGremainder over 60 minutesPt Weight:80 M9; I:F H;Q T<\ E=g S g   " Jb "8XtPA Criteria> tPA Indications,'P+' d,Pc,  Medical History Exclusions:YClinical Exam Exclusions:>0 M?; I@F HAQ TB\ ECg SU/ Calculator  &BTx,>p">TjtPA Induced ICHManagement of Suspected ICH6Following tPA*1.*Stop tPA Immediately72.7STAT Noncontrast head CTDVitals every 15 minutesD3.Q4.QOxygen 2L NC, Maintain Sats >95%^5.^Labs: CBC, PT/PTT, Fibrinogen, T&Ci4 Units pRBCs, 4 Units FFP/CryovContact: Neurosurg, Family, PMDv6.Strict BP Cntrl (Nipride/Labetolol)7. $ If ICHD0 ME; IFF HGQ TH\ EIg S s  &* RjDVT Prophylaxis  Select{!ICH 0-3 DaysICH >4 DaysICH with DVT/PE-aP,a Select Situation:J0 MK; ILF HMQ TN\ EOg S i    (@dElevated INR Management SelectBLife Threatening BleedingSerious Bleeding (Any Elev. INR)INR (supratherapeutic but <5)INR 5-9; No BleedingINR 9-20; No BleedingINR >20; No Bleeding-?P,? xPw Select INR Situation:mDisposition:P0 MQ; IRF HSQ TT\ EUg S _ ,Dfz,TpICH Rates Intracerebral Hemorrhage Rates&Following Fibrinolysis1ICH Rate 71Fibrinolysis Reason! A3-9%"P6%# _10.9%$n0.5-0.6%%7AIntravenous tPA (Stroke)&7PIV & IA tPA (Stroke)'7_IA Prourokinase (Stroke)(7nThrombolytics Agents for)7yother causesV0 MW; IXF HYQ TZ\ E[g S Y F\,Pf|ICH ScoreA$ 3-4Z$ 5-12s$ 13-158i ICH Volume >=30cm3m9 ?H Intraventricular HemorrhageX Infratentorial Origin of ICHhF Age >=80 yo?$ Calcv" Clear%GCS Score:Check All That Apply:\0 M]; I^F H_Q T`\ Eag S  0J r 2H^tAnticoagulation Resumption6V Artificial ValveC A-Fib (no stroke), Elderly w/Lobar?\" Calck%j% OICH or Poor Neuro FunctioningDecision to Resume Anti-coagulation After ICH (for VTE)")Select Patient Factors:0 M; IF HQ T\ Eg S u  RV ~$:BP Management (ICH)| Select}!SBP >200, MAP >150SBP >180, MAP >130 (Elev ICP)SBP >180, MAP >130 (No Elev ICP)|}~-dP,d {Select Situation:b0 Mc; IdF HeQ Tf\ Egg Sv   & | 0Jp0Heparin Induced ICHt) BPc6< Selectp6/,<30 min30-60 min60-120 min>120 min?C" Calce+d+ Heparin Induced Intracerebral)1.Dose of Heparin Received:0Hemorrhage62.Time Since Last Dose:YProtamine Sulfate Dosing:)Unitsh0 Mi; IjF HkQ Tl\ Emg S  @V~&P8b.DICH Volume EstimationyC *C BPP *P BP] *] BPj BP?w" Calc @Pof Intracerebral HemorrhageABC/2 Method For Estimating Volume]4.Enter # of Slices ICH Seen (c) Estimated Volume (cm3):P3.Enter Diameter at 90 Degr (b)j5.Enter Thickness of Slices (in cm) 6Intraparenchymal Hemorrhage+1.Select CT Slice w/Largest Area ofC2.Enter Largest Diameter (a)n0 Mo; IpF HqQ Tr\ Esg S ` (N<Rh~ICP Managementb Management of Elevated ICP in ICHj#1.Elevate head of bed to 30 degreesk12.Analgesia & Sedationl?3.CSF Drainage via Ventricular Cath.mM4.Osmotic Diuretics (Hypertonicn XSaline, Mannitol)pf5.Neuromuscular Blockadeqt6.Hyperventilationz7.Barbiturate Comat0 Mu; IvF HwQ Tx\ Eyg So x  ":ZpPhysiologic Managementr!GlucoseSeizuresTemperatureBOAO Select Situation:z0 M{; I|F H}Q T~\ Eg Sy  :Tr$:V~Corrected Phenytoin Z, BP >A$ Calc7c1P>|$ Clear ,Serum Albumin:Total Phenytoin: XCorrected Phenytoin:0 M; IF HQ T\ Eg Sw' FormulaZ BPomg/dlo,g/dl  z~ &<RhCranial Nerves Selectn CN ICN IICN IIICN IVCN VCN VICN VIICN VIIICN IXCN XCN XICN XIIReferences-a,aȀ Select a Cranial Nerve:0 M; IF HQ T\ Eg S ]   6LbDiagnostic TestszPz 0 M; IF HQ T\ Eg S W  ^b~  :ZpGlasgow Coma Score2x select)2k,Spontaneous: 4To Speech: 3To Pain: 2None: 1Ox select)Ok7Oriented: 5Confused: 4Inappropriate Words: 3Nonspecific Sounds: 2None: 1nx select)nk,Follows Commands: 6Localizes Pain: 5Withdraws to Pain: 4Abnormal Flexion: 3Abnormal Extension: 2None: 1>$ Calc'Eye OpeningcMotor ResponseDVerbal Response&Adult GCS Score:0 M; IF HQ T\ Eg S[ $:PfKey History Elements zPz 0 M; IF HQ T\ Eg S  ,Fbv*@VlHounsfield ?CT Hounsfield Units6BoneEAcute BloodTNormal BraincWaterrAirjq-1000jc0jT30-40jE80-100j61000'Substancej'HU0 M; IF HQ T\ Eg S \ *Rl &:Pf|Mean Art Pressure]L BP_L/ BPaAg Pc>?$ Calcj>~$ Clearf\Mean Arterial Pressure:dSystolic BP:igmmHgp`hmmHg /QApproximateq /Diastolic BP:rg/mmHg0 M; IF HQ T\ Eg Sgx& Formulac 6 ^vStroke Mimics 7Complicated MigraineConversion DisorderHypertensive EncephalopathyHypoglycemiaSeizuresY5PX5 Select Situation:0 M; IF HQ T\ Eg S   >TjStroke Imaging-a,a  Selectc Diffusion Weighted ImagingFLAIRMagnetic Resonance SpectroscopyMagnetic Resonance AngiographyNoncontrast Head CTPerfusion Weighted ImagingT1 Weighted ImagesT2 Weighted ImagesReferencesSelect Type of Imaging:0 M; IF HQ T\ Eg S  tSAH Management0#coming soon!0 M; IF HQ T\ Eg S   6LbStroke Resources}P} 0 M; IF HQ T\ Eg S s   $Lf0F\rTemperature{VH Select|c;CelsiusFahrenheit{|tV. BPv>A$ Calc>g$Pz>|$ Clear~[Converted Temperature:}Temp. Unit:w.Temperature:0 M; IF HQ T\ Eg Sxx& FormulaZ  "&Nh(>TjWeight ConversionlVH Selectmc;KilogramPoundlm]V. BPa>A$ Calcp9c-Pj>|$ Clearc+.Weight:nWeight Unit:o XConverted Weight:0 M; IF HQ T\ Eg Sew' Formula n EMCREG Internationalwww.emcreg.org&r^(866) 4EMCREGx$ back`d`؀   0X@Rj2H^ABCD2 Score  9 Age >=60  ,G BP >=140/90  H Unilateral Weakness  S Speech Disturbance w/o Weakness  a7 Diabetes 6p1 10-59 min gp1 >=60 min ?" Calcn;3.o ;Clinical Features (Choose One):pp5.q pDuration:tCheck All That Apply:}-2.~1.b4.0 M; IF HQ T\ Eg Sl  du w  6LbxABCD2 Commentary{m | xssy zby Ben Bassin, MD0 M; IF HQ T\ Eg S= 0Hbz &@Zt$:PCincinnati Prehosp Stroke>1$ FaceE42 ?KV2 NmlLq2# AbNml?B# ArmM3C ?SVC NmlTqC# AbNml@S. 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Calci- Cinci PHSS\x" ClearjG4.Pt Ambulatory Prior to EventkT5.Blood Glucose 60-400l 1.Pt Age > 45 yon-2.Hx of Seizureso:3.New Neuro Sx in Last 24 Hrspa6.Asymmetry on Physical?:sYtN^Check All That Apply:0 M; IF HQ T\ Eg Sc  &<R .T,Modified Rankin ScoreB ?PQ ?b` ?o ?V~ ? mRS Method to Assess Severity ofFunctional Impairment Post-Stroke30...No symptoms at allB1...No disability despite symptomsQ2...Slight disability`3...Moderate disabilityo4...Moderately severe disability~5...Severe disability0 M; IF HQ T\ Eg S ! ,Vj.FVlWFNS Scale (SAH)" # World Federation of Neuro-$(of Subarachnoid Hemorrhage%<Grade&(<Description'K1(X2)e3*r4+(KGCS 15,(XGCS 13-14, No Focal Deficit-(eGCS 13-14, + Focal Deficit.(rGCS 7-12052(GCS 3-630 M4; I5F H6Q T7\ E8g S9logical Surgeons Classification; ,BXnBrain Death Examv+^P*^w m0 Mn; IoF HpQ Tq\ Erg Ss tClinical Criteria for Brain Deathuin Children & Adults = ,Tv&<Rh~Hypercoag TestingEHypercoagulation LabG(Recommended for Routine:HcDepends on Pt. 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