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Stroke

Protocols

Stroke(Ischaemic & Haemorrhagic) Management :

Clinical Features:

  • 1)Sudden numbness or weakness in the face, arm or leg (especially on one side of the body).
  • 2)Sudden confusion or trouble speaking or understanding speech.
  • 3)Sudden vision problems in one or both eyes.
  • 4)Sudden difficulty walking or dizziness, loss of balance or problems with coordination.
Risk Factor:
  • 1)High blood pressure.
  • 2)Heart disease.
  • 3)Diabetes.
  • 4)Smoking.
  • 5)Birth control pills (oral contraceptives)
  • 6)History of TIAs (transient ischemic attacks).
  • 7)High red blood cell count.
  • 8)High blood cholesterol and lipids.
investigations:
  • 1)CT Scan of brain ([post id="263" title="cerebral-infarction"])
  • 2)serum electrolyte
  • 3)serum lipid profile 
  • 4)serum creatinine
  • 5)RBS
  • 6)ECG
Rx: 

A.General Management:

  • Diet:Soft&liquid or NPO
  • Continuous Catheterization if patient acute retension or incontinence
  • O2 inhlation sos
  • NG Feeding - 200 ml/2 hrly
  • Change Posture 2 hrly

1.Inf.Normal Saline/saloride(1L)..I/V @10 d/m

2.Inj.Oricef([post id="398" title="Ceftriaxone"])(1gm)...1 vial I/V stat & BD

3. Inj.Maxpro([post id="392" title="Esomeprazole"])(40mg)...1apm I/V stat & BD

 If Eye infection :

  • Iventi E/D([post id="415" title="Moxifloxacin"])...1 drop each eye 4 times daily ...7-10 days
if Oral infection :
  • Gelora/micoral gel([post id="565" title="Miconazole"] ...orally 3 times daily)
if Constipation :

Then

  • Syrp.Avolac([post id="515" title="Lactulose"]) ...3 TSF ..3times daily 
if Fever : 
  • Tab.[post id="449" title="Paracetamol"](Napa)(500mg) 

2+2+2

If patient Diabetic:
  • inj.Insulin start consult with endocrinologist
if Patient Restlessness:


B. Specific Mnagement:


 if Ischaemic Stroke:

1.Tab.cereton(5 mg)....1+1+1...continue

2.Tab.Carva([post id="860" title="Aspirin"])(75mg)...0+1+0(after meal)....continue

3.Tab.ATV ([post id="864" title="Atorvastatin"])(10 mg)...0+0+1...continue


 If Haemorrhagic Stroke:

1. Inj.Oradexon...1 amp I/V stat & 6 hrly

2.Inf.Osmosol(mannitrol 20%)(500ml-1mg/kg stat)...250 ml I/V running stat &

Then

150 ml(0.5mg/kg)... I/V... 8 hrly... 3 days 

Note For Mannitol:

  • when given-If midline shifting 
  • Patient must catheterization before giving mannitol
If haemorrhagic stroke with convulsion :
  • Tab.D-toin (phenytoin)(100mg)...1+0+1
 If haemorrhagic stroke with Ventricular Extension :


Advice :
  • 1) lifestyle modification
  • 2)control BP
  • 3)control Cholesterol
  • 4)control Diabetes

❤❤❤যে অল্পতে তুষ্ট থাকে তার কাছে এ পৃথিবীর সব কষ্ট সহজ হয়ে যায়।❤❤❤


During Discharge of hospital :(ischemic stroke)

Rx:

1.Cap.Denver ([post id="399" title="Cefixime"])(400mg) 1+0+1…………...7 days

2.Tab.Carva([post id="860" title="Aspirin"])((75mg) 0+1+0(after meal )….continue

3.Tab.Ripril  (2.5mg)(Ramipril) 0+0+1……………...continue

4.Tab.ATV ([post id="864" title="Atorvastatin"])(10 mg)...0+0+1...continue

5.Cap.Maxpro([post id="392" title="Esomeprazole"])((20mg) 1+0+1(30min before meal)...15 days

6.Tab.Cavinton(5mg) 1+1+1………….3 months

7.Tab.Quiet (25mg/100mg) 0+0+1……….1 month


Advice:
  • Physiotherapy 
  • Regulary intake drug
  • Follow up regularly



Hemorragic stroke(discharge from hospital):

RX:

1.Cap.Denver ([post id="399" title="Cefixime"])(400mg) 1+0+1…………...7 days

2.Cap.Maxpro([post id="392" title="Esomeprazole"])((20mg) 1+0+1(30min before meal)...15 days

3.Tab.Quiet (25mg/100mg) 0+0+1……….1 month

4.Tab.Anadol([post id="453" title="Tramadol-Hydrochloride"])(50mg) 1+0+1(if pain after meal)….10 days

5.Tab.Decason([post id="472" title="Dexamethasone"])(0.5mg) 3+3+3(after meal)…..7 days

6.Syrp.Avolac ([post id="515" title="Lactulose"])....3 tsf 3 times daily ……...14 days( constipation থাকলে)

7.Tab.D-Toin(100mg) 1+0+2 ……….1 month


If Haemorrhagic Stroke: Ventricular extention:


Advice:
  • Physiotherapy 
  • Regulary intake drug
  • Follow up regularly