Management

While the re is little that can b e done to treat a stroke once it has o ccurred, there are several imp ortant s upp ortive meas ures that need to be considered while the patient is recovering.

Ventilation

If the patient has an inadequate ventilatory drive, then he will require prolonged ventilation until his respiratory drive center recovers. This will also apply if the patient is unable to protect his airway and clear secretions. If after 2 weeks of intubat ion and mechanical ventilat ion, the patient has st ill not progresse d to weaning, then a tracheostomy should b e performed in order to avoid the long term complications of intubation. These patients seem to be more prone to developing bouts of sepsis from infected lines, pneumonia or urinary tract infections.

Nutrition

Ideally, this should b e orally if possib le, or by a NG tube. If long term, then should use a so ft silast ic tube to avoid irritation of the nose. If there is inadequate absorption of feeds, or contraindication to enteral feedings, then TPN will be required. Consult a dietitian for nutritional requirements. Stop enteral feeds when planning to extubate.

Deep Vein Thrombosis (DVT) Prophylaxis

Heparin 5000 units s.c. q12h

Physiotherapy

Assistanc e is very important to help with clearing of secretions and to maintain range of motion of limbs and amb ulation where possible.

Support

The patient and his family w ill require support as they deal with this p oten-tially terrible complication. It is particularly in this situat ion that nursing staff and other allied health personnel (physiotherapists, occupational therapists and social workers) are very helpful.

Rehabilitation

Once the patient has been weaned from the ventilator and shows signs of recovery, then planning can b egin for transfer to the ward and then to a stroke rehabilitat ion unit. Early consultation with the rehabilitat ion staff can be very helpful in facilitat ing recovery and timely transfer.

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