Stroke is something that you will come across acutely in your practice whether you are working in a rural Emergency Department or dealing with the after-stroke care in a busy urban setting, not to mention all of the prevention and education that you can do prior to a stroke.
EXAM STUDY TIPS
The Canadian Stroke Best Practice Recommendations were recently updated and there are some great tips for post-stroke care that would also be excellent fodder for the exam.
If someone asked you what some of the common complications and consequences of stroke are, would you be ready to rattle off 5 or 6 of them? A simple start is to think of the 7 D’s.
Decubitus Ulcer
Disability
Depression
Dysphagia
Dementia - Vascular Cognitive Impairment
Death
Dog-Tired (Fatigue)
Stepping back from post-stroke care let’s think about some of the major modifiable risk factors for stroke.
Number one for me is SMOKING. It’s so tough in practice to have patients quit but so exciting when they do. For the exam, think of smoking cessation as a free point on the exam for every patient who smokes – but only if you remember to mention it! Remember Management = More than Medication!
Other things you can do for your patient to prevent stroke include optimizing the ABCDEs:
A. Fib
Blood pressure
Cardiac disease
Diabetes
EtOH
Overwhelmed? Going to have a stroke just thinking about how you will study for the topic?
The Review Course staff work hard to distill the information you need to know for the exam and also help prepare you for the real world after the exam to make you a more confident and prepared family physician. Be sure to register today if you aren't one of the dozens of residents already signed up!
Read on for some of our educational hints to help you study, retain and prepare for whatever the exam might throw at you whether it’s a mock patient, a short answer question, or real life practice!
PEARLS FOR PRACTICE
I still recall the dread and fear I had when a patient had a stroke in front of me in a small emergency department hours away from a CT scanner in rural Saskatchewan. With a suspected stroke ‘time is brain’ but it’s important to ensure you don’t forget the basics while you quickly work the patient up.
You have probably heard the mantra ‘DEFG – Don’t Ever Forget Glucose!’
Not only does it fit with the D theme for stroke above, but it’s very important for the exam and even more so for clinical practice (imagine an exam question asking “What initial testing would you order?”). Even more important is having a full understanding of what resources are available to you when you start practice in a new place.
Take 30 seconds to sit with the nursing staff or clinic staff and ask:
What do you have available for an MI or Stroke?
Where is the crash cart / emergency kit?
How do I contact the specialists in an emergency?
If you’re starting your own clinic a useful brief video and checklist for how to prepare a family practice office for emergencies is available at www.OfficeEmergencies.ca.*
A few other helpful things to know:
How do you arrange air ambulance?
How far away is the nearest CT?
What are the ground ambulance capabilities in your community?
Thinking about these things in advance can save you valuable minutes when the stress of an incoming stroke patient is raising your blood pressure.
Reference Eskes GA, Lanctot KL, Herrmann N, et al; Heart Stroke Foundation Canada Canadian Stroke Best Practices Committees. Canadian stroke best practice recommendations: mood, cognition and fatigue following stroke practice guidelines, update 2015. Int J Stroke 2015 Jun 29. http://onlinelibrary.wiley.com/doi/10.1111/ijs.12557/full (accessed July 18, 2015).
*Disclosure: Dr. Simon Moore from The Review Course made the video at www.OfficeEmergencies.ca but does not collect any financial income from that project, originally designed as a resident research project.