However, just the physical presence of a CT scanner is not sufficient. Expertise in the assessment of subtile early infarctions may be essential not only for identification of patients who may be treated with thrombolytics, but also for patients with bad prognosis and risk of secondary haemorrhage and herniation. In some instances, especially if an expert Doppler study can be performed without delay, it can be done prior to CT scan. In selected cases with pre-existing cardiac disease, history of arrhythmias and unstable blood pressure, online ECG monitoring is desirable. The electrodes for cardiac monitoring can also be used for respiratory monitor ing.
Respiratory action is checked clinically if there is no continuous monitoring.
Blood pressure monitoring can be performed discontinuously using repetitive automatic inflatable sphygmomanometry or with a mobile 24-hour blood pressure monitoring device. Most of the times, conventional blood pressure monitoring is adequate. Pulse oxymetry is frequently used for continuous monitoring in stroke units. It provides relevant information on the patient's respiratory status. A central catheter and occasionally central venous pressure monitoring is needed for patients with severe stroke treated in specialised wards.