Ischemic Stroke without Intervention

Impression:

Acute Ischemic Stroke:

- Manifestations: ***
- NIHSS: ***
- PTA antithrombotic: ***
- TNK/EVT: ***
- Presumed Etiology: ***

Plan:

Neurological:
- Neurological checks q1h
- Seizure, fall, aspiration precautions
- Head of bed at 30 degrees at all times
- Permissive hypertension with goal SBP < 220
- No free water, mix everything in NS as this can worsen cerebral edema
- PT/OT/ST consults initiated

Stroke Workup:

- Initial CTH:
- CTA: ***
- MRI brain: ***
- Stroke labs: A1C *** , LDL ***
- Telemetry: ***
- TTE: ***
- Meds:
Aspirin 81mg daily
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Respiratory:
- Aspiration precautions, head of bed above 30 degrees
- Baseline CXR
- Suctioning q1-2 hours
- Meds:
- None
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Cardiology:
- Continuous cardiac telemetry
- SBP goal < 220 (permissive hypertension)
- Meds:
-Nicardine drip (target SBP < 220)
-Labetalol 10mg IV q4h prn
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Renal:
- Renal function normal
- Monitor daily BMP
- Foley with temperature probe for strict I&O monitoring in critical care setting
- Avoid hypotonic fluids as this can worsen cerebral edema
- Meds:
- NS @ 75ml/h
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Gastrointestinal:
- NPO for now till formal speech evaluation
- Last BM: unknown
- Meds:
Docusate 100 mg PO TID
Pantoprazole 40mg tab
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Endocrinology:
- FSBS q6hr while NPO
- Check HgbA1c, LDL
- Meds:
Insulin SS
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Hematology:
- Monitor CBC daily
- SCDs for prophylaxis; enoxaparin 40mg SC daily
- Meds:
- enoxaparin 40mg SC daily
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Infectious Disease:

- Current access: PIVs (placed)
- Will get a PICC line
- Keep normothermic, aggressive fever control as this worsens neurological outcomes
- Meds:
none
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Prophylaxis:

DVT: SCDs, enoxaparin 40mg SC daily
GI: pantoprazole, docusate
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Consults:
Physical therapy
Occupational therapy
Speech therapy
Nutrition
Case Management
Social Work
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Discharge Planning:

Patient requires ICU level of care for close monitoring of cerebral edema.
Patient was discussed with the neurocritical care attending who agrees with current plan of management.