Professional Documents
Culture Documents
Initial assessment
General assessment
Airway breathing,
circulation
Blood sugar- keep at RBS
50-200mg/dL
Good hydration
Normal temperature
Blood pressurecautiously lower if
>220/120
Treat hypertension after 7
days
Treat of hypertensive
Urgent CT if,
Thrombolysis or early
anticoagulation
Already on anticoagulation
Known bleeding tendency
Altered level of consciousness
Fluctuating symptoms
Fever, neck stiffness, papilloedema
severe headache at onset
Infarction
Neurological assessment
Level of consciousness
Severity of stroke
Time of onset
Swallowing- 50ml water swallow test
NBM until swallowing assessed
Bladder/ bowel care
Surgical interventions
Other investigations
Secondary prevention
Should be individualized
Implement soon after stroke / TIA
Antiplatelet-Aspirin 50-300mg/day
Aspirin+Dipyradamole MR superior to aspirin alone
Clopidogrel if aspirin contraindicated
Aspirin+Clopidogrel- not recommended
Anticoagulation- start after 14 days if indicated
Stop smoking/ reduce alcohol
Weight reduction/ dietary modification
Target BP
non diabetic<140/85
diabetic<130/80
ACEI+thiazide diuretic best combination
Lipid lowering- treat all if total cholestrol>135mg/dL
SAH
Urgent CT scan brain and if there is
evidence SAH contact and transfer to NSU
urgently
If no CT available and with deteriorating
level of consciousness- contact and
transfer to a NSU
If no CT available and condition is stable LP
If CT negative- do LP
Analgesia- avoid Pethidine/ morphine
Nimodipine 60mg 4 hourly for 21 days
Monitor- hydrocephalus, ischaemia,
rebleed, electrolytes. Hypotension
Rehabilitation
Should start ASAP
Multidisciplinary assessment
Physiotherapy- start within 24 hours,
atleast twice/day
Nutrition
Speech therapy
Occupational therapy
Pain assessment
DVT prevention
Bladder bowel care
Spasticity management
Psychiatric assessment
Neuropsychological assessment
Other diagnosis
T reat accordingly
Basic tests
FBC, ESR, CRP, LFT, renal profile, lipid
profile, CXR, ECG
Special tests
Discharge Plan
Involve patient, carer, MOH/ primary
care team, social service
Nominate key worker
Detailed discharge summary/card
Plan long-term rehabilitation (Home/
community/ institution)
Take patients domestic situation into