Section | Recommendations |
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General care/nursing care | All patients should be admitted to an acute stroke unit or intensive care unit. Frequent vital sign checks, neurological assessment and continuous cardiopulmonary monitoring (pulse oximetry, automated BP cuff and ECG telemetry) should be performed. |
Airway protection | Ventilation should be considered for patients with impending ventilator failure, at risk of aspiration, signs of raised intracranial pressure or brainstem dysfunction. |
ICP monitoring | ICP should be monitored in patients with IVH, hydrocephalus, signs of transtentorial herniation or GCS≤8 that were presumably caused by haematoma mass effect. |
Maintenance of ICP of <20 mmHg and CPP of 50–70 mmHg is reasonable. | |
Blood pressure | In patients with acute sICH presenting within 6 hours of symptom onset, blood pressure should be lowered to SBP<140 mmHg within 1 hour. |
VTE prophylaxis | Intermittent pneumatic compression should be used. Graduated compression stockings should be avoided. |
Dysphagia screening | Patients should be kept nil by mouth until a formal swallowing assessment is done. |
Fever | High grade fever of >38°C should be treated with paracetamol and/or tepid sponging. |
Glucose | Hypoglycaemia and hyperglycaemia should be treated. In treating hyperglycaemia, insulin should be used. |
Intravenous fluid | Avoid over-hydration. Avoid dextrose-containing fluid. |
Seizure | Patients with clinical seizure(s) should be treated with antiepileptic agent(s). Patients without seizure should not be prophylactically treated with antiepileptic agent(s). |
Patients with altered conscious level and epileptic discharges detected on electroencephalography should be treated with antiepileptic agents. | |
DNAR order | Early DNAR order should be avoided in the first few days as it may limit active medical treatment. |
BP = blood pressure; CPP = cerebral perfusion pressure; DNAR = do not attempt resuscitation; ECG = electrocardiogram; GCS = Glasgow Coma Scale; ICP = intracranial pressure; IVH = intraventricular haemorrhage; SBP = systolic blood pressure; sICH = spontaneous intracerebral haemorrhage; VTE = venous thromboembolism