Adult Medical Emergency Handbook - Scottish Intensive Care Society

• After the first week blood pressure lowering with an ACE inhibitor
and thiazide diuretic should be considered even if blood pressure
is “normal”.
• Patients with a proven ischaemic stroke who are in atrial fibrillation
should be considered for anticoagulation after 2 weeks.
• If AF is symptomatic (e.g. palpitations or breathlessness)
consideration should also be given to subsequent chemical or
electrical cardioversion.
• All patients with ischaemic stroke who are shown to have a severe
stenosis (>70%) of the ipsilateral internal carotid artery on the
carotid duplex should be referred to Professor Dennis or Dr Keir
(WGH), Dr Chapman or Dr Hart (RIE) or Dr S Ramsay on ext 53846
(SJH) for further consideration of carotid endarterectomy.
TIA
• TIA is a medical emergency with a 12% risk of stroke in the
following days.
• Patients with TIA should be commenced immediately on
secondary prevention with aspirin 300mg stat. then 75mg daily,
dipyridamole retard 200mg bd and a statin. Consider addition of
ACE inhibitor & thiazide diuretic if BP > 125/75 mmHg.
• Refer urgently for Neurovascular Clinic assessment where
neuroimaging & carotid Doppler ultrasound will be performed.
• Contact the TIA Hotline for advice and clinic appointments on
0131-536-1019
• For West Lothian patients contact Dr Ramsay’s secretary Mrs
Evans on ext 523846 or fax 01506-523842.
adult medical emergencies handbook | NHS LOTHIAN: UNIVERSITY HOSPITALS DIVISION | 2009/11
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