167 - Evaluation of Stroke Patients in Intensive Care Settings

Abstract

This chapter discusses evaluation of stroke patients in intensive care settings. The treatment of stroke begins with evaluation of the stability of the patient's vital signs which dictates supportive care necessary to prevent acute complications. The major airway concerns are adequacy of airway protection, ventilation, and gas exchange. All stroke patients should be given supplemental O2 initially. A quick physical assessment of respiratory function includes observation of the quality and rate of the respirations. Hypotension is detrimental and should be treated aggressively. The presence of hypotension suggests the possible presence of a serious complication such as myocardial ischemia or infarction, sepsis, or brainstem dysfunction from ischemia or compression. Volume expansion with normal saline or albumin is the first line treatment. Computed tomography (CT) is sensitive for distinguishing acute hemorrhage from pale infarction. This distinction is crucial for appropriate early management. Conditions requiring emergent surgical intervention such as an epidural, subdural, or intraparenchymal hematoma, or subarachnoid hemorrhage are easily detected by head CT. The presence of any of these findings should prompt early discussion with neurosurgery.