AIS A&P Note

Symptom: ***

Etiology: {}

Acute Ischemic Stroke Thearpy:

- NIHSS =
- Out of Window
- Admit to Floor vs NICU
- Telemetery
- Workup for cause of stroke
- Stroke risk factor reduction

Acute Ischemic Stroke Work-up:

- MRI Brain without Contrast
- MRA Head without Contrast
- MRA Neck without Contrast
- Trans-thoracic Echo-cardiogram
- UA, Urinary Drug Screen
- HbA1c, Lipid Panel, ESR, CRP
- Telemetery, EKG
- CBC, CMP, Mg, PO4
- PT/PTT/INR

***Acute Ischemic Stroke in Young Work-up:(If applicable)

- Anticardiolipin antibodies
- Lupus Anticoagulants
- Protein S
- Protein C
- Activated Protein C resistance
- Antithrombin III
- Homocysteine
- Fibrinogen
- Antinuclear Antibody
- Lipoprotein (a),
- Serum Protein Electrophoresis
- Hemoglobin Electrophoresis
- Sickle-cell Assay
- Prothrombin Mutation G20210A testing
- ESR, CRP, RPR
- Complement

Ischemic Stroke Risk Reduction and Management:

- ASA 325mg PO QDay; First Dose STAT

- Telemetry Review

Blood Pressure Control

- Permissive HTN till SBP 220 or DBP 120

- Don't drop BP more than 15%/Day

- Keep SBP > 160

- *** PRN Labetolol or Hydrlazine IV 10mg for SBP >220 or DBP > 110 if know stenosis

Hyperlipidemia

- Lipid Panel

- Will Treat Hyper-Lipidemia

Diabetes

- HbA1c

- SSI for now; will D/C if HbA1C < 6.4

***Atrial Fibrillation (USE If in Afib)

- Telemetry Review DOES NOT show Afib

- CHADS2VAC Score =

Speech:

- Bedside Swallow Eval

- Speech Therapy

FEN:

- NPO till swallow evaluation completed

- NSS 75ml/Hour

DVT:

- Sub Q Heparin 5000 mg SQ TID

- SCDs

Disposition/Discharge Planning

- PT/OT Eval

- Social Work Consult