Patient can have weakness, numbness, altered mental status, confusion, fall etc
ER:
Routine Labs, EKG, CXR, CT Head with out contrast
Oxygen
Code Stroke if suspecting a CVA—> Neurologist responds and evaluates for tPA administration
ABCD2 Score 2-day Stroke Risk for TIA cases
0-3 1.0% Hospital observation may be unnecessary without another indication (e.g. new AFib)
4-5 4.1% Hospital observation justified in most situations
6-7 8.1% Hospital observation worthwhile
Hospitalist:
Telemetry-Observation for TIA and Admission for CVA
Bed rest
NPO until bedside dysphagia evaluation by RN for TIAs and until speech therapy sees for CVA with slurred speech
Neurology Consult
ECHO-Call cardiology if Afib or severe cardiomyopathy
Carotid Doppler-Vascular surgery if severe stenosis
Lipid panel
Neuro-assessment every 4hrs
PT/OT/Speech therapy evaluation
IV fluids
UA-Lot of UTIs can be associated with CVA.
MRI/MRA of brain
ASA or Aggrenox (Can cause Head aches in some at which time, change to ASA and Plavix)
ACEI for BP, May need permissive HTN for CVA.
Statin for High cholesterol
DVT prophylaxis
Patient may need Heparin drip if INR is sub therapeutic for patients on Coumadin for AFib, if patient does not have intracranial hemorrhage.
Lot of patients need 1mg PO Ativan to undergo MRI for claustrophobia.
Social Worker for placement to rehab or NH if PT/OT recommends in cases of CVA with weakness
Case Manager to arrange if patient needs PT at home
Here is the NIH stroke scale
