Acute Ischemic Stroke

Acute Ischemic Stroke - Early Management

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Treatment Table 7. Potential Approaches to Arterial Hypertension in Acute Ischemic Stroke Patients Who Are Candidates for Acute Reperfusion Therapy ÎÎPatient otherwise eligible for acute reperfusion therapy except that BP is >185/110 mm Hg: •  Labetalol 10-20 mg IV over 1-2 minutes, may repeat 1 time OR •  Nicardipine 5 mg/h IV, titrate up by 2.5 mg/h q 5-15 min, maximum   15 mg/h (When desired BP reached, adjust to maintain proper BP limits.) OR •  Other agents (hydralazine, enalaprilat, etc.) may be considered when appropriate ÎÎIf BP is not maintained ≤185/110 mm Hg, do NOT administer rtPA ÎÎManagement of BP during and after rtPA or other acute reperfusion therapy to maintain BP ≤180/105 mm Hg: •  Monitor BP q 15 min for 2 hours from the start of rtPA therapy, then q 30 min for 6 hours, and then qh for 16 hours ÎÎIf systolic BP >180-230 mm Hg or diastolic BP >105-120 mm Hg: •  Labetalol 10 mg IV followed by continuous IV infusion 2-8 mg/min OR •  Nicardipine 5 mg/h IV, titrate up to desired effect by 2.5 mg/h q 5-15 min, maximum 15 mg/h ÎÎIf BP not controlled or diastolic BP >140 mm Hg, consider IV sodium nitroprusside. General Supportive Care and Treatment of Acute Complications ÎÎProvide airway support and ventilatory assistance for patients with acute stroke who have decreased consciousness or who have bulbar dysfunction that causes compromise of the airway (I-C). ÎÎProvide supplemental oxygen to maintain oxygen saturation >94% (I-C). ÎÎSupplemental oxygen is NOT recommended in nonhypoxic patients with acute ischemic stroke (III-B). ÎÎIdentify and treat sources of hyperthermia (temperature >38°C), and administer antipyretic medications to lower temperature in hyperthermic patients with stroke (I-C). ÎÎCardiac monitoring is recommended to screen for atrial fibrillation and other potentially serious cardiac arrhythmias that would necessitate emergency cardiac interventions. Cardiac monitoring should be performed for at least the first 24 hours (I-B). 10

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