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Supportive Care/Addressing Complications (Revised)
The Basics:
• Cardiac monitoring
• Oxygen and hypovolemia correction
• Lower BP in those not receiving fibrinolysis; medication only if BP > 200 mm Hg/120 mmHg
• Pre-existing hypertension→ Restart medication
• Treat glucose abnormalities
Revised: Cardiac monitoring for at least 24 hours is recommended to screen for arrhythmias, which, if present, should be corrected. Hypovolemia should be corrected with IV saline, and supplemental oxygen should be administered to achieve > 94% saturation. Lowering BP by 15% during the first 24 hours following stroke onset is considered a reasonable goal in patients with high BP not receiving fibrinolysis, bearing in mind that, according to the new guidelines, "consensus exists that medications should be withheld unless the systolic BP is > 220 mm Hg or the diastolic BP is > 120 mm Hg." Antihypertensive medications can be restarted in stable patients with pre-existing hypertension after 24 hours, and one trial even supports resuming therapy within 24 hours. Blood glucose < 60 mg/dL should be treated, ideally to normal, and hyperglycemia should be treated to a range of 140-180 mg/dL.
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