Acute Ischemic Stroke A 59-year-old teacher is admitted to the ICU following fibrinolytic therapy for acute ischemic stroke. She has a history of atrial fibrillation and diet-controlled diabetes. For...

Acute Ischemic Stroke

A 59-year-old teacher is admitted to the ICU following fibrinolytic therapy for acute ischemic stroke. She has a history of atrial fibrillation and diet-controlled diabetes. For the last 3 weeks, she has complained to her husband about some minor heart palpitations, but has not been to the doctor. She dcvdoped left arm hemiplegia, a left facial droop, and slurred speech while eating lunch at her desk. A student found the patient slumped against her desk when he returned to the classroom to retrieve a book. The student called 911. The paramedics established time of symptom onset by discovering that the student last saw her teacher normal about 20 minutes prior

Upon arrival at the ER, she was quickly transported to head CT and the stroke team completed the necessary prefibrinolytic evaluation. No blood was present on CT, and recombinant tissue plasminogen activator {rtPA) was administered. On admission to the ICU, her left arm weakness is beginning to resolve (strength 215) and her speech is almost normal. She is monitored in the ICU for 24 hours and diagnosed with atrial fibrillation. After 24 hours in the ICU, she is transferred to a tdcmetry bed in the stroke unit, where she is started on aspirin and later warfarin. She is discharged home after 4 days in the hospital, with outpatient occupational therapy.

How would treatment prioritie1 differ if the patient'• CT had revealed an intracranial hemorrhage (ICH)?

How often should vital 1ign1 and neurological use11ment be performed for a patient who hu n:ceiTI:d rtPA for acne i1chemic 1troke?