Acute Ischemic Stroke

Acute Ischemic Stroke - Early Management

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ÎÎAt present, no pharmacologic agents with putative neuroprotective actions have demonstrated efficacy in improving outcomes after ischemic stroke, and therefore, other neuroprotective agents are NOT recommended (III-A). ÎÎWith the exception of stroke secondary to air embolization, hyperbaric oxygen is NOT recommended for treatment of patients with acute ischemic stroke (III-B). Note: Data on the utility of hyperbaric oxygen are inconclusive, and some data imply that the intervention may be harmful. Surgical Interventions ÎÎThe usefulness of emergent or urgent carotid endarterectomy is not well established when: •  clinical indicators or brain imaging suggests a small infarct core with a large territory at risk (eg, penumbra) •  circulation is compromised by inadequate flow from a critical carotid stenosis or occlusion •  acute neurological deficit after carotid endarterectomy may be caused by thrombosis of the surgical site (IIb-B). ÎÎIn patients with unstable neurological status (either stroke-inevolution or crescendo TIA), the efficacy of emergent or urgent carotid endarterectomy is not well established (IIb-B). Admission to the Hospital and General Acute Treatment (After Hospitalization) ÎÎUse comprehensive specialized stroke care (stroke units) that incorporates rehabilitation (I-A). ÎÎTreat patients with suspected pneumonia or urinary tract infections with appropriate antibiotics (I-A). ÎAdminister subcutaneous anticoagulants for treatment of immobilized Î patients to prevent deep vein thrombosis (I-A). ÎÎUse standardized stroke care order sets to improve general management (I-B). ÎÎAssess swallowing before the patient begins eating, drinking, or receiving oral medications (I-B). ÎÎPatients who cannot take solid food and liquids orally should receive nasogastric, nasoduodenal, or percutaneous endoscopic gastrostomy tube feedings to maintain hydration and nutrition while undergoing efforts to restore swallowing (I-B). ÎÎMobilize less severely affected patients early and take measures to prevent subacute complications of stroke (I-C). 19

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