Delirium Tx in Stroke

[MSKalltheway]

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Was just looking for some quick advice. I've got a 70 something y/o pt who came in with a large L sided CVA. Has been getting agitated and requires pharmocologic sedation, basically since 4 nurses are required to prevent pt from getting out of bed, but not necessarily hitting someone by accident...

Anyways, was wondering what the options are for agitation in acute stroke. Obviously, benzos are out. Haldol is out. I would give Seroquel, but pt cant swallow and there is no IV form. Is there anything IV I can give for sedation without compromising neurologic recovery? Have not seen a good option in the literature yet...

Thanks all for your help as always!

 

[eljefe]

if a large L CVA not sure why it takes 4 nurses to keep her in bed...

assuming you have ruled out other causes (meds, infection, etc.) what about zyprexa zydis oral wafers?

 

[oreosandsake]

I think in general, for agitation in the setting of brain neuro-rehab you want to...
1) reduce the environmental stimulants (dont put the pt in the room in front of the nurses, the activity/noise outside will get them going due to over stimulation) --> cancel overnight vitals if pt is stable, so you dont wake them up in the middle of the night, schedule toileting etc so pts have a set "routine"
2) reduce physical constraints if possible
3) reorient pt - put familar home photos, objects in room
4) have nurse walk the pt at night if ambulatory, to "tire them out"

we used a lot of trazadone at rancho

if pt has high bp, can use beta blocker - i think propanolol.. ?

consider valproic acid or tegretol

but yeah, we used trazadone a lot, and had the nurses walk the pts if ambulatory. dont let them sleep in the daytime, and put them at the end of the hall so they dont get lots of foot traffic

edit: on re-read, i'm not sure if trazadone comes in IV... pretty sure propranolol does

 

[topwise]

The patient can't swallow at all? How is he getting nutrition and other non-IV meds? Maybe a PEG is indicated, then you have more medication options. Otherwise, you're pretty limited.

 

[RUOkie]

iv zyprexa. But I agree with the PEG and more importantly, work on the environment. GET A SITTER! and avoid physical restraints.