Post-Treatment Guidelines & Recommendations

Post Treatment Care - Antihypertensive Therapy
  

SBP 180 - 230 or DBP 105-120 mm Hg	Labetalol 10 mg IV, may repeat / double to 150 mg max Labetalol drip 2-8 mg / min
SBP > 230 or DBP 121 - 140 mm Hg	Above Sodium nitroprusside
DBP > 140 mm Hg	Sodium nitroprusside (0.5 ug/kg per minute)
May consider enalapril in patients with CHF, asthma, abnormal cardiac conduction Check with current guidelines

ICH Contingency Plan

• Stat CT
• STAT labs
  > (fibrinogen, CBC, PT/PTT)
• Type and screen
• Fresh frozen plasma
• Neurosurgical consult

Management of Seizures

Prophylactic anticonvulsant medication not recommended

Recurrent seizures require treatment

• Diazepam 5 mg over 2 minutes
• Lorazepam 1-4 mg over 2–10 minutes
• Follow benzodiazepines with longer acting anticonvulsant (phenytoin, phenobarbital, etc.)

Pneumonia After Stroke

• One third of stroke patients develop a pneumonia within 1 month
• 3rd leading cause of death in the first month
• Estimated cost per event $10,000 and a 7 day length of stay
• Laryngeal cough reflex cough tests can identify patients at risk

Source: Addington, Stroke 1999

Rehabilitation

Early rehabilitation is key for recovery

Early mobilization also prevents:

• Deep venous thromboses and pulmonary emboli
• Decubitus ulcers
• Contractures
• Malnutrition
• Pneumonias
• UTI

What do you need to treat?

• Preplanning and preparation
• Multidisciplinary approach
• Know the mechanics
• Know the risks
• Coordinated post-treatment care

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This presentation was written by Dr. Edward C. Jauch of the Greater Cincinnati / Northern Kentucky Stroke Team at the University of Cincinnati College of Medicine.

Last Revised: March 26, 2001