Neurology and Therapeutics

Stroke Management

The goal for the acute management / Stroke Management of patients with stroke is to stabilize the patient and to complete initial evaluation and assessment, including imaging and laboratory studies, within 60 minutes of patient arrival. Critical decisions focus on the need for intubation, blood pressure control, and determination of risk/benefit for thrombolytic intervention. General Management of Patients With Acute Stroke:

Blood glucose :Treat hypoglycemia with D50

Treat hyperglycemia with insulin if serum glucose >200 mg/dL

Blood pressure: For thrombolysis candidates and non candidates

Cardiac monitor: Continuous monitoring for ischemic changes or atrial fibrillation

Intravenous fluids: Avoid D5W and excessive fluid administration

IV isotonic sodium chloride solution at 50 mL/h unless otherwise indicated

Oral intake: NPO initially; aspiration risk is great, avoid oral intake until swallowing assessed

Oxygen: Supplement if indicated (Sa02< 94%)

Temperature: Avoid hyperthermia; use oral or rectal acetaminophen and cooling blankets as needed

• Thrombolytic Therapy
• Stabilization of Airway and Breathing
• Intravenous Access and Cardiac Monitoring