Template for plan of management (ICH patient, intubated)
Plan:
Neurological:
- Neurological checks q1h
- Seizure, fall, aspiration precautions
- Head of bed at 30 degrees at all times
- SBP goal 100-160
- CTH:
- No free water, mix everything in NS as this can worsen cerebral edema
- PT/OT/ST consults initiated
- Meds:
- - APAP 500 mg PO q6h PRN for pain or headache
___________________
Respiratory:
- Aspiration precautions, head of bed above 30 degrees
- PRN O2
- Chest PT with vest q4hr
- Baseline CXR
- Suctioning q1-2 hours
- Meds:
- Duonebs q4h
_______________________________________________
Cardiology:
- Continuous cardiac telemetry
- SBP goal 100-160
- Meds:
-Nicardine drip (target SBP < 160)
-Labetalol 10mg IV q4h prn
________________________________________________
Renal:
- Renal function normal
- Monitor daily BMP, Mg, Phos
- Foley with temperature probe for strict I&O monitoring in critical care setting
- Avoid hypotonic fluids as this can worsen cerebral edema
- Meds:
- IVFs as above
_______________________________________________
Gastrointestinal:
- NPO
- Place Dobhoff tube for medication/nutrition; Abdominal X-ray to confirm placement ordered
- Start tube feeding with Peptamen 1.5 @ 10cc/hr and titrate to goal 50cc/hr as tolerated
- Hold TF for residuals > 300
- Last BM: unknown
- Meds:
- Docusate 100 mg PO TID
- Famitidine 20mg tab bid
________________________________________________
Endocrinology:
- FSBS q6hr while NPO/TF
- Check HgbA1c, TSH
- Meds:
- Insulin SS
- Hypoglycemia protocol
________________________________________________
Hematology:
- Monitor CBC daily
- SCDs for prophylaxis; no heparins given ICH
- Meds:
- None
________________________________________________
Infectious Disease:
- Current access: PIVs (placed)
- Keep normothermic, aggressive fever control as this worsens neurological outcomes
- Meds:
-APAP 500mg q6h prn fever > 38.3
_______________________________________________
Prophylaxis:
DVT: SCDs, no anticoagulation in the setting of recent ICH
GI: famotidine, docusate
________________________________________________
Consults:
Neurosurgery
Physical therapy
Occupational therapy
Speech therapy
Nutrition
Case Management
Social Work
________________________________________________
Discharge Planning:
Patient requires ICU level of care for monitoring of progression of cerebral edema.
Patient was discussed with the neurocritical care attending who agrees with current plan of management.