BUMC Basics.pdf - Anesthesia Home

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3. Stop anticoagulants and reverse coagulopathies,
vitamin K, FFP
4. Insulin for hyperglycemia
5. Usually hypertensive: treat to MAP 100-120; maintain
CPP (MAP-ICP) >60-70.
6. HTN is usually labile use gtt: nicardipine, nipride or
labetalol based on other comorbidities.
7. Load with Dilantin or cerebyx to levels of
approximately 20. Most indicated in lobar ICH, SAH,
or subcortical ICH with diameter >4cm and shift.
8. Treat ICP (goal < 20): elevate HOB to 30 degrees,
sedate using propofol, mannitol IV at 1 g/kg bolus
followed by 0.5 to 0.25g/kg q6hours(follow Na, Posmkeep
300 to 320), hyperventilate (goal pC02 25-30)
9. Bilateral SCD’s for DVT prophylaxis
CVA: Ischemic
• Admit using ischemic stroke protocol
• If indicated, admit to stroke unit (3 Truett)
Labs — CBC, CMP, Fasting Lipid level, DFS, HgbA1C, PT,
PTT, utox, hypercoagulable work-up and blood cultures on
young patients
Imaging — Stat CT head without contrast to evaluate for
hemorrhage, MRI/MRA head and neck or CTA head and neck,
Carotid Doppler if you do not obtain other imaging of the
neck(carotids), EKG, TEE in patients who are suspected to
have embolic stroke without known source (Afib), TTE with
Bubble study is acceptable as screen in others if low suspicion
of central embolic process (cross out TEE on protocol as you
want to order TTE with bubble study instead)
Treatment:
1. If