Template for plan of management (ICH patient, not 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
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Respiratory:
- Aspiration precautions, head of bed above 30 degrees
- PRN O2
- Chest PT with vest q4hr
- Baseline CXR
- Suctioning q1-2 hours
- Meds:
- None
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Cardiology:
- Continuous cardiac telemetry
- SBP goal 100-160
- Meds:
-Nicardine drip (target SBP < 160)
-Labetalol 10mg IV q4h prn
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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
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Gastrointestinal:
- NPO for now
- Last BM: unknown
- Meds:
- Docusate 100 mg PO TID
- Famitidine 20mg tab bid
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Endocrinology:
- FSBS q6hr while NPO/TF
- Check HgbA1c, TSH
- Meds:
- Insulin SS
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Hematology:
- Monitor CBC daily
- SCDs for prophylaxis; no heparin given acute ICH
- Meds:
- None
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Infectious Disease:
- Current access: PIVs (placed)
- Keep normothermic, aggressive fever control as this worsens neurological outcomes
- Meds:
-none
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Prophylaxis:
DVT: SCDs, no anticoagulation in the setting of recent ICH
GI: famotidine, docusate
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Consults:
Physical therapy
Occupational therapy
Speech therapy
Nutrition
Case Management
Social Work
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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.