Metabolic and Poison
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Outside hospital: IV/IM benzylpenicillin
ABC, high flow Oxygen, IV+fluid resuscitation
Contact an aesthetist
ABC: open and maintain the airway, lay in recovery position, remove false teeth if poorly fitting, insert oral/nasal airway, intubate if necessary
100% oxygen + suction as required
IV access, take blood:
U+E, LFT, FBC, glucose (exclude hypoglycaemia)
Toxicology screen if indicated, anticonvulsant levels
Thiamine IV if alcoholism. Unless glucose known to be normal deliver.
Correct hypotension with fluids
Slow IV fluid bolus of
If seizures continue:
Last resort is general anaesthesia
Airway: Put in recovery position. Refer to Speach and Language team to check swallowing.
Breathing: Deliver oxygen.
Circulation: IV access, and ensure hydration.
Measure and treat hypoglycaemia
Investigations: Urine sample
ECG (atrial fibrillation?)
Bloods: FBC, U+E, glucose, lipids, platelets, clotting (brain haemorrhage?), ESR
CXR. Carotid doppler. Consider echo heart.
CT: urgent if less than 3h or posterior circulation lesino, otherwise 3-5d
Treatment: Aspirin 300mg, consider thrombolysis.
Treat pressure sores, give NG tube and catheterise if necessary. DVT prophylaxis.
Secondary stroke prevention measure
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