Template for plan of management (Large ischemic Stroke without tPA or thrombectomy)Plan:
Neurological:
– Neurological checks q1h
– Seizure, fall, aspiration precautions
– Head of bed at 30 degrees at all times
– Permissive hypertension with goal SBP < 220
– No free water, mix everything in NS as this can worsen cerebral edema
– PT/OT/ST consults initiated Stroke Workup:
– Initial CTH:
– CTA:
– MRI brain:
– Stroke labs: TSH, A1C, LDL
– Telemetry, TTE: – Meds:
– Aspirin 325mg daily ___________________
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 < 220 (permissive hypertension)
– Meds:
-Nicardine drip (target SBP < 220)
-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:
– NS @ 75ml/h
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Gastrointestinal:
– NPO for now till formal speech evaluation
– Last BM: unknown
– Meds:
– Docusate 100 mg PO TID
– Famitidine 20mg tab bid
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Endocrinology:
– FSBS q6hr while NPO
– Check HgbA1c, TSH
– Meds:
– Insulin SS
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Hematology:
– Monitor CBC daily
– SCDs for prophylaxis; enoxaparin 40mg SC daily
– Meds:
– enoxaparin 40mg SC daily
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Infectious Disease:
– Current access: PIVs (placed)
– Will get a PICC line
– Keep normothermic, aggressive fever control as this worsens neurological outcomes
– Meds:
-none
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Prophylaxis:
DVT: SCDs, enoxaparin 40mg SC daily
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 close monitoring of cerebral edema.
Patient was discussed with the neurocritical care attending who agrees with current plan of management.