TIA or Acute CVA admission

Patient can have weakness, numbness, altered mental status, confusion, fall etc

ER:

Routine Labs, EKG, CXR, CT Head with out contrast

Oxygen

Code Stroke if suspecting a CVA—> Neurologist responds and evaluates for tPA administration

ABCD2 Score 2-day Stroke Risk for TIA cases

0-3 1.0% Hospital observation may be unnecessary without another indication (e.g. new AFib)

4-5 4.1% Hospital observation justified in most situations

6-7 8.1% Hospital observation worthwhile

Hospitalist:

Telemetry-Observation for TIA and Admission for CVA

Bed rest

NPO until bedside dysphagia evaluation by RN for TIAs and until speech therapy sees for CVA with slurred speech

Neurology Consult

ECHO-Call cardiology if Afib or severe cardiomyopathy

Carotid Doppler-Vascular surgery if severe stenosis

Lipid panel

Neuro-assessment every 4hrs

PT/OT/Speech therapy evaluation

IV fluids

UA-Lot of UTIs can be associated with CVA.

MRI/MRA of brain

ASA or Aggrenox (Can cause Head aches in some at which time, change to ASA and Plavix)

ACEI for BP, May need permissive HTN for CVA.

Statin for High cholesterol

DVT prophylaxis

Patient may need Heparin drip if INR is sub therapeutic for patients on Coumadin for AFib, if patient does not have intracranial hemorrhage.

Lot of patients need 1mg PO Ativan to undergo MRI for claustrophobia.

Social Worker for placement to rehab or NH if PT/OT recommends in cases of CVA with weakness

Case Manager to arrange if patient needs PT at home

Here is the NIH stroke scale

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