Acute Form 2004 - Riks-Stroke Page 2
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4----------------------------------------------------------- RISK FACTORS ----------------------------------------------
Alternative answers are 1= yes
2= no
9= unknown
Previous stroke? (Excluding TIA)
I___I
Auricular fibrillation at onset of stroke? (including intermittent fibrillation or flutter)
I___I
Diabetes, previously known or newly diagnosed?
I___I
Treatment for hypertension at onset of stroke?
I___I
Is the patient a smoker? (>one cigarette/day, or quit during the last three months)
I___I
--------------------------------------------------- ACUTE MANAGEMENT ------------------------------------------
Level of consciousness on arrival to hospital
I___I
1= fully awake (RLS 1)
2= drowsy but responding to stimulus (RLS 2-3)
3= unconscious (RLS 4-8)
9= unknown
CT scan during hospital stay 1= yes
2= no
9= unknown
I___I
Has the patient been informed to stop smoking? 1= yes
2= no
9= unknown
I___I
--------------------------------------------------- MEDICAL TREATMENT ------------------------------------------
please refer to MANUAL for Riks-Stroke 7.0 for a complete list of pharmaceuticals
alternative answers are 1= yes
2= no
9= unknown
On admission
On discharge
Diuretics
I___I
I___I
ACE /A2 inhibitors
I___I
I___I
Beta blockers
I___I
I___I
Calcium inhibitors
I___I
I___I
Statin
I___I
I___I
ASA
I___I
I___I
Klopidogrel
I___I
I___I
ASA + dia
I___I
I___I
Dipyridamol
I___I
I___I
Warfarin
I___I
I___I
During care
Heparin against progressive stroke
I___I
Heparin as a preventive thrombolityc treatment
I___I
--------------------------------------------------- THROMBOLYTIC TREATMENT ---------------------------------------
alternative answers are 1= yes
2= no
9= unknown
Thrombolysis – given in cases of stroke, Actilyse etc.
I___I
Alarm made for thrombolysis “save the brain/stroke alarm”
I___I
Cerebral haemorrhage with clinical symptoms <36 hrs after initiation of treatment
(must have been verified with CT scan or through autopsy)
I___I
Did the patient’s status improve in an evident manner?
(i.e. speech recovery, paresis disappeared) within 2 hrs from initiation of care
I___I
Time for initiation of thrombolysis (hour, minute)
I___II___I.I___II___I
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