AIS without tPA

Template for plan of management of AIS without tPA (Ischemic Stroke without tPA)


Stroke acute management:
- Admit to stroke unit
- Frequent neuro-checks (q4h)
- Permissive HTN for 24h
- Baseline EKG and CXR
- Basic labs: CBC, CMP, coagulation panel and troponin
- Intravenous hydration with normal saline at 75cc per hour
- Patient passed bedside swallow eval, started on dysphagia diet. ***
- Head of bed > 30 degrees for aspiration prevention and aspiration precautions ordered.

Stroke workup:
-Trans-thoracic echocardiogram
-Continuous cardiac telemetry to monitor for arrhythmia
-Stroke labwork: HgbA1C, lipid panel, urine drug screen

Secondary prevention of stroke:
-Aspirin 325mg daily
-Atorvastatin 40 mg daily (long-term goal LDL < 70)
-Tight glucose control (long-term goal HgbA1c < 6%)
-Stroke education and counseling

Stroke rehabilitation:
-Physical therapy, occupational therapy, speech therapy consults
-Consulted social work and case management for help with discharge

Other medical issues:


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

Patient will be staffed with the stroke attending during morning rounds.