Acute management (first hours) for stroke

ABCS

1. Ensure airway

2. Monitor blood glucose

3. Monitor BP

a. But treating even very high may harm b/c autoreg impaired, even a 20% fall may compromise cerebral perfusion

4. Urgent CT/MRI if : *CT will rule out py haemorrhage *MRI most sensitive for an acute infarct

i. cerebellar hemartomas may need urgent evac

i. ie alt diagnosis likely

i. decreased GCS, raised ICP signs, severe headache, meningism, progressive symps, known bleeding tendency or anticoagulation

5. Thrombolysis

i. Major infarct or haemorrhage on CT

ii. Mild (non-disabling) deficits

iii. Recent surg, trauma, or obstetric delivery

iv. Past CNS haemorrhage

v. AVMalform or aneurysm

vi. Severe liver disease, varices, or portal hypertens

vii. Seizures at presentation

viii. Recent arterial or venous punct at non compressible site

ix. Anticoags or PTT >15s

x. Platelet

xi. BP >220/130

6. ‘Nil by mouth’ until swallowing assessed

7. Keep hydrated

8. Explain what has happened

a. Communic fully w/pt, rels + carers over difficult decisions eg deciding on kindest lvl of intervention taking into account qual of life, coexist condits, prognosis

9. Antiplatelet agents- once hemorrhagic stroke exclude, give aspirin 300mg

10. Admission to stroke unit for specialist nursing/physio saves lives + is great motivator

	Created by greenfylde almost 11 years ago

Neuro + Head and Neck Note on Acute management (first hours) for stroke, created by greenfylde on 10/12/2013.