Assessment & Plan (short)
#Ischemic Stroke
Patient with focal neuro deficits characterized by ***. Last seen normal at ***. On imaging noted to have ***. Contraindications to TPA reviewed, with decision to ***.
Dx
- NIHSS score ***
- Stat NCHCT/CTA, Neuro consult
- Glucose FS, INR, CBC, Cholesterol, A1c
- EKG, Tele, consider TTE with bubble if <60 y.o
Tx
- If TPA given, ICU admission, Q1hr neuro checks x 24 until repeat NCHCT. BP goal <185/110 (Nicardipine preferred).
- If TPA not given, BP goal <220/120
- Antiplatelet agent
Assessment & Plan (long)
#Ischemic Stroke
Patient with focal neuro deficits characterized by ***. Last seen normal at ***. On imaging noted to have ***. Contraindications to TPA reviewed, with decision to ***. If given TPA, symptomatic ICH occurs in ~6% with 50% mortality. If large vessel occlusion in anterior circulation and <16h or even <24h LSN, consider mechanical thrombectomy. If cardioembolic etiology, give antiplatelet, with transition to AC in 4d to 2 weeks.
Dx
- NIHSS score ***
- Stat NCHCT/CTA, Neuro consult
- Glucose FS, INR, CBC, Cholesterol, A1c
- EKG, Tele, consider TTE with bubble if <60 y.o
Tx
- If TPA given, ICU admission, Q1hr neuro checks x 24 until repeat NCHCT. BP goal <185/110 (Nicardipine preferred).
- If TPA not given, BP goal <220/120
- Antiplatelet agent
Organ systems
Medical field
Author
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Originally created: July 5, 2020 by Eric Lee
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