CT brain scans should be requested as soon as possible after admission, and immediate scanning should be carried out in the following instances:
After CT brain:
If CT scan shows no haemorrhage, prescribe a 'one-off' dose of aspirin oral 300mg (or PR if swallow impaired). Ensure Aspirin is given immediately i.e. do not leave for administration at next morning's drug round.
If patient has had thrombolysis, delay aspirin initiation for 24 hours. After the initial stat dose of aspirin, further antiplatelet therapy should be prescribed according to the NHSGGC Stroke Antiplatelet Guidelines (see NHSGGC StaffNet, Clinical Guidelines Electronic Resource Directory and search under 'Cardiovascular system').
If CT scan shows haemorrhage:
If CT scan shows an alternative pathology (e.g. tumour, subdural haematoma), discuss with consultant.
Temperature >37.5ºC and evidence of infection:
If aspiration probable, commence appropriate antibiotic therapy while awaiting culture results (see infections section) and give:
Paracetamol (oral or per rectum) 1g every four to six hours as required (maximum dose 4g/day) N.B. Consider dose reduction in patients with low body weight (<50kg), renal impairment, glutathione deficiency (chronic malnourishment, chronic alcoholism) to 15mg/kg/dose up to four times daily (max 60mg/kg/day). An example is: paracetamol oral 500mg four times daily. N.B.Patients with chronic liver failure may require a further dose adjustment (7.5mg/kg/dose, max 30mg/kg/day).