By Ken Uchino
You might have simply encountered a potential stroke sufferer. You wonder: what should still I do first? How do i do know it's a stroke? Is it too past due to opposite the wear and tear? How do I do the suitable issues within the correct order? This publication might help you resolution those severe questions. It presents sensible suggestion at the care of stroke sufferers in a number of acute settings. The content material is prepared in chronological order, masking the issues to contemplate in assessing and treating the sufferer within the emergency division, the stroke unit after which on move to a rehabilitation facility. all kinds of stroke are coated. This new version offers up to date info from lately accomplished medical trials and extra info on endovascular treatment, hemicraniectomy for serious stroke, DVT prophylaxis and stroke prevention. A entire set of appendices comprise precious reference info together with dosing algorithms, conversion elements and stroke scales.
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Additional info for Acute Stroke Care
Dictate a discharge summary that includes the above thought processes (see Appendix 4 for sample). n General timeline The following is a general timeline for the care of stroke patients. It is affected by the severity of the stroke, extent of diagnostic work-up necessary to determine etiology, ability to swallow, and amount of early recovery. The goal is to get patients discharged from acute hospitalization as quickly and as safely as possible. Stroke unit for 1–3 days. Then to the general ward to ﬁnish work-up and disposition determination.
Ask yourself why the patient is not on antiplatelets, statins, ACE inhibitors – because most patients on the stroke service should be (except people with ICH or on anticoagulation). What are we doing to promote recovery? What are we doing to prevent complications from the stroke? ■ Don’t forget DVT prophylaxis. ■ Ask yourself why the patient still has a Foley catheter and IV ﬂuids if the patient is being discharged soon. What is the disposition? Think about disposition early: ■ Consult physical therapy, occupational therapy, and rehabilitation.
N The four components of ischemic stroke care There are four components to caring for people with acute ischemic stroke. At every point, you should be thinking about the four issues: (1) Acute therapy and optimization of neurological status. (2) Etiological work-up for secondary prevention. (3) Prevention of neurological deterioration or medical complications. (4) Recovery and rehabilitation. This chapter discusses the four components in brief, and then there are longer discussions on the following topics: TPA therapy (Chapter 4).
Acute Stroke Care by Ken Uchino