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A 95-year-old man presents to the emergency department with…
A 95-year-old man presents to the emergency department with sudden onset inability to speak or use the right side of his body. His family noticed these changes roughly 5.5 hours prior to presentation. The patient has an extensive past medical history including hypertension, multiple prior strokes, coronary artery disease, obesity, diabetes, and dementia with significant difficulty caring for himself. He uses a wheelchair at baseline and does not meaningfully communicate or interact with others. His power of attorney and family states that the patient is not to undergo invasive procedures, cardiopulmonary resuscitation, or intubation in the event of a cardiac arrest or respiratory failure. His temperature is 98.3°F (36.8°C), blood pressure is 167/105 mmHg, pulse is 92/min, respirations are 14/min, and oxygen saturation is 99% on room air. Physical exam reveals a disheveled man. He is aphasic and does not move his right upper or lower extremities. He has 4/5 strength in his left upper and lower extremities which is his baseline. He does not follow commands and only withdraws to pain. A computed tomography (CT) scan of the head and CT angiography of the head and neck reveal a left middle cerebral artery occlusion. Which of the following is the most appropriate management for this patient?
A 95-year-old man presents to the emergency department with…
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A 95-yeаr-оld mаn presents tо the emergency depаrtment with sudden оnset inability to speak or use the right side of his body. His family noticed these changes roughly 5.5 hours prior to presentation. The patient has an extensive past medical history including hypertension, multiple prior strokes, coronary artery disease, obesity, diabetes, and dementia with significant difficulty caring for himself. He uses a wheelchair at baseline and does not meaningfully communicate or interact with others. His power of attorney and family states that the patient is not to undergo invasive procedures, cardiopulmonary resuscitation, or intubation in the event of a cardiac arrest or respiratory failure. His temperature is 98.3°F (36.8°C), blood pressure is 167/105 mmHg, pulse is 92/min, respirations are 14/min, and oxygen saturation is 99% on room air. Physical exam reveals a disheveled man. He is aphasic and does not move his right upper or lower extremities. He has 4/5 strength in his left upper and lower extremities which is his baseline. He does not follow commands and only withdraws to pain. A computed tomography (CT) scan of the head and CT angiography of the head and neck reveal a left middle cerebral artery occlusion. Which of the following is the most appropriate management for this patient?
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