Treatment plan for AIS without tPA (Ischemic Stroke without tPA)
Impression:
Acute Ischemic Stroke:
- Manifestations: ***
- NIHSS: ***
- PTA antithrombotic: ***
- TNK/EVT: ***
- Presumed Etiology: ***
Plan:
Stroke acute management:
- Admit to stroke unit
- Frequent neuro-checks (q4h)
- Permissive HTN for 24h
- Baseline EKG
- Basic labs: CBC, CMP, coagulation panel and troponin
- Bedside swallow evaluation
- Head of bed > 30 degrees for aspiration precautions
Stroke workup:
-CTH: ***
-CTA: ***
-MRI: ***
-TTE: ***
-LDL: *** -A1C:***
-Continuous cardiac telemetry
Secondary prevention of stroke:
-Aspirin 81mg daily
-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.