NeurologyResidents

Template for plan of management of AIS after tPA (Ischemic Stroke after tPA)

Impression: 

Acute Ischemic Stroke:
- Manifestations: ***
- NIHSS: ***
- PTA antithrombotic: ***
- TNK/EVT: TNK given at ***
- Presumed Etiology: ***

Plan: 

Stroke acute management:
- Admit to stroke unit
- Neurochecks Per TNK protocol
- Permissive HTN up to SBP 180
- Baseline EKG
- Basic labs: CBC,CMP, coagulation panel and troponin
- Bedside swallow assessment
- Head of bed > 30 degrees for aspiration precautions

After TNK administration (Started at ***):
>Neurochecks: q15 mins x two hours, then q30 mins x6 hours, then q1hour x 16 hours.
>No foley removal or placement for 24 hours
>No venous/arterial puncture at non-compressible site
>No anticoagulation or anti-platelet agents for 24 hours
>Cardene drip as needed to keep BP < 180/105

Stroke workup:
-CTH: ***
-CTA: ***
-MRI: ***
-TTE: ***
-LDL: ***                   -A1C:***
-Continuous cardiac telemetry

Secondary prevention of stroke:
-Aspirin 81mg daily will be started 24h post tPA
-Atorvastatin 40 mg daily (long-term goal LDL < 70)
-Tight glucose control (long-term goal HgbA1c < 6%)
-Stroke education and counseling

Stroke rehabilitation:
-PT, OT, ST consults
-Consulted case manager for discharge disposition

Other medical issues:
HTN: ***
DM: ***

​Prophylaxis: SCDs (DVT), heparin 5000u q8h

Patient was staffed with the stroke attending during morning rounds.