Treatment
(1)Admit to HDU:A recent stroke patient within 48 hours should be monitored in HDU for 72 hours!
(2)Tolerate BP up to 220/120 mm Hg for the acute phase.
(3)If systolic pressure>220 mm Hg,the blood pressure should be decrease slowly.e.g.by hydralazine 5mg until lowered by 10%~15%.
(4)Fasting and water-deprivation until swallowing evaluation was finished.
(5)Oxygenation:Maintain O2 saturation>92%.
(6)IV fluids:correction dehydration.
(7)Anticonvulsants if needed,e.g diazepam 10mg
(8)Treat fever aggressively,T>38℃with ice pack and antipyretics
(9)Hyperglycemic control(<180 mg/d L=10 mmol/L,avoid hypoglycemia)
(10)Physiotherapy to start immediately,instruct guardians
(11)Prevent and treat any complications:Aspiration pneumonia,pulmonary embolism,Pressure sores,spasticity,depression seizures,dementia.
①Primary Prevention of stroke(ischaemic and haemorrhagic):
Reduction of high blood pressure,stopping smoking,weight reduction.
Cholesterol reduction,Control the blood sugar.(https://www.daowen.com)
Prevent and treat infections(e.g.HIV,Syphilis,TB).
②Secondary prevention ischaemic stroke or TIA:
Antiplatelet agents,e.g.aspirin 75~150 mg qd(for ischaemic).
Anticoagulation with warfarin 5~7.5 mg/d,overlap 3 days with heparin or LMW heparin if atrial fibrillation occur.
Abbreviations
SBE:亚急性心内膜炎
VDRL:梅毒血清检测
HZ(hydralazine):肼苯哒嗪
ADMIT:承认
HDU:高依赖病房
TIA:短暂性脑缺血发作
LMWH(low molecular weight heparin):低分子肝素
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