M1 Neuro

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Author:
stan5155
ID:
97371
Filename:
M1 Neuro
Updated:
2011-08-17 21:47:23
Tags:
Neurological
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Description:
Neurological Protocols
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  1. Acute Stroke
    Blood glucose

    4.5 hour onset

    Cincinnati Stroke assessment

    • Not received TPA Cardene or Labetalol for MAP > 130
    • Cardene: 5 mg/hr(50 ml/hr) increased every 15 by 2.5 mg not to exceed 15mg/hr
    • Labetalol: initial 0.25 mg/kg, double every 10 min until desired effect or 300 mg given.

    Post TPA maintain BP < 180 and DBP < 110

    Zofran 4 mg every 15 min max of 12 mg
  2. Hypertensive Encephalopathy
    Target a 25% decrease of MAP from the initial

    MAP SBP+DBP+DBP/3

    Initiate Labetalol or Cardene for BP >180 or DBP >120
  3. Subarachnoid Hemorrhage
    SpO2 98%, IV x 2, immobilization

    BP > 120 consider Cardene 5 mg/hr increased by 2.5 mg every 15 minutes up to 15 mg/hr.

    Consider Labetalol 10 mg IV doubled x 1 after 15 minutes

    Medical Control for Mannitol 0.5 mg/kg IV over 30 minutes if signs of herniation

    ETCO2 25-30 mmHg
  4. Intercerebral Hemorrhage
    SpO2 98%, IV's x 2, immobilize

    BP > 140 consider Cardene 5 mg/hr increased every 15 min by 2.5 mg to max of 15 mg/hr.

    Consider Labetalol 10 mg IV double in 15 minutes if still elevated

    Medical Control for Mannitol 0.5 mg/kg IV over 30 minutes if signs of herniation

    ETCO2 25-30 mmHg
  5. Seizure
    Blood glucose

    Known alcoholic or Thiamine deficiency administer Thiamine 100 mg IV prior to D50.

    Lorazepam 2 mg IV slow IVP repeat every 5 min to max of 10 mg.

    Valium PR 0.5mg/kg

    Cerebyx 15 PE/kg IV or IM not to exceed 150 mg/kg

    Dilantin 15 mg/kg IV loading dose not to exceed rate of 50 mg/min

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