Adult Medical Emergency Handbook - Scottish Intensive Care Society

ICP for Acute Admission following SUSPECTED STROKE v3.5, post mdt 25/08/06
Phase 2 – planning for transfer to ward
NHS Lothian
IF YES TO ANY QUESTION initial when done
Hydration Drowsy or unsafe swallow N Y Prescribe IV 0.9% Saline depending on state of
hydration. Avoid Dextrose in first 48hrs: 2/4/6 rule
Temperature Temp > 37.5 o C N Y Prescribe Paracetamol 1g 4-6 hrly oral / IV / PR
Take blood cultures, look for & treat infection
Blood Sugar Glucose >11mmol/L N Y Prescribe dextrose / potassium / insulin infusion (see
(4hrly BM’s)
GKI ICP)
DVT Not mobilising independently N Y Consider CLOTS trial enrolment (unless PVD,
prophylaxis
neuropathy or ulcers). Avoid Heparin
Swallow
screen
Swallow screen failed N Y Referral to S. & L. T., consider need for medications,
fluid & food
Continence Incontinent of urine N Y Avoid urinary catheterisation unless renal failure, skin
broken or acute urinary retention
Positioning
Nutritional
screen
Clinical
Trials
Perform Moving & Handling
Assessment
Complete nutrition screen
Document weight
consider : CLOTS - Y / N/A
Trial C - Y / N/A
Nurse 30 o Head-up if drowsy or NG fed, & Physio
referral prior to transfer (if not for transfer on bed)
Consider Modified diet or NG feeding at 24 hrs and
referral to Dietitian
Trial B - Y / N/A
Trial D - Y / N/A
IF ISCHAEMIC STROKE or & include date / time sent
Carotid Duplex scan If TIA or minor non-disabling stroke & considering endarterectomy initial
Transthoracic
If in AF, recent MI, cardiac murmur or bilateral infarcts
initial
Echocardiogram Bubble contrast echo if 3.5mmol/l
N Y prescribe Simvastatin* 40mg first choice initial
* (Pravastatin if already stabilised on warfarin, as Simvastatin interacts)
IF