Adult Medical Emergency Handbook - Scottish Intensive Care Society

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• If there are doubts about the patient’s ability to swallow safely the
patient should be placed nil by mouth and given intravenous fluids.
• Urinary catheterisation should be avoided in the acute phase
unless there is urinary retention, a high risk of pressure sores
or unless the urine output needs to be monitored. Discuss with
Nursing staff.
• DVT Prophylaxis: avoid Heparin.
INVESTIGATION
• Immediate BM to exclude hypoglycaemia
• U&E’s, and glucose
• LFTs, cholesterol
• FBC, ESR
• ECG
• CXR
CT scan should be requested immediately & be performed as
soon as possible after stroke onset.
• If clinical evidence of a cardiac source of embolism e.g.
atrial fibrillation or significant cardiac murmur, request an
echocardiogram.
• If the patient has had a minor stroke or TIA affecting the carotid
territory arrange a carotid duplex to screen for significant carotid
stenosis.
INDICATIONS FOR IMMEDIATE CT SCANNING
• Coma or reducing conscious level.
• Likelihood of important non-stroke diagnosis (e.g. subdural
haematoma, subarachnoid haemorrhage).
• Patient on or requiring anticoagulants.
• Patient eligible for thrombolysis.
• Unusual presentation? Basilar artery thrombosis.
Young patients (< 60 years old) with a large middle cerebral
artery infarct are at risk of significant cerebral oedema
developing within 48 hours of stroke onset. GCS & neuroobservations
should be monitored closely & if the clinical
condition deteriorates further CT scanning is indicated & the
patient should be discussed with the Neurosurgeon on-call to
consider hemicraniectomy & surgical decompression.
adult medical emergencies handbook | NHS LOTHIAN: UNIVERSITY HOSPITALS DIVISION | 2009/11
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