national-clinical-guidelines-for-stroke-fourth-edition

National clinical guideline for stroke
I Parenteral drugs aimed at lowering blood pressure should only normally be given to
people with acute stroke in the context of a clinical trial, apart from people with acute
intracerebral haemorrhage and a systolic blood pressure of more than 200 mmHg
who may need parenteral treatment, or people who need acute blood-pressure
lowering in preparation for thrombolysis.
J Parenteral drugs aimed at raising blood pressure should only normally be used as part
of a clinical trial.
K Prescription of antibiotics to prevent infection after stroke should only be given in the
context of a clinical trial.
4.12.2 Sources
A Middleton et al 2011
B Consensus
C–G National Institute for Health and Clinical Excellence 2008b
H Consensus
I Geeganage and Bath 2008; Geeganage and Bath 2010; Potter et al 2009; consensus
J Potter et al 2009
K van de Beek et al 2009
4.12.3 Implications
It is essential that all hospitals admitting people with acute cerebrovascular events have
an acute stroke unit able to provide specialised high-dependency nursing and medical
care.
4.13 Initial, early rehabilitation assessment
A majority of patients will have some disability after stroke, and a mixture of specific
impairments. Some problems are common, others less so; some problems are obvious,
others less so. This set of recommendations concerns the initial assessment undertaken
while the patient is still in the acute phase, often quite ill. Further assessments can and
should be undertaken later, but this set of recommendations focuses on those that are
important in the first 48 hours.
The goals of the early rehabilitation assessment are to identify major impairments that
may not be obvious but that may have an influence on early management, guide
prognosis and draw attention to immediate rehabilitation needs.
4.13.1 Recommendations
A All patients should be assessed within a maximum of 4 hours of admission for their:
● ability to swallow, using a validated swallow screening test (eg 50 ml water swallow)
administered by an appropriately trained person
● immediate needs in relation to positioning, mobilisation, moving and handling
● bladder control
54 © Royal College of Physicians 2012