AISpostTpa
Posted On February 17, 2020
First 24 hr post TPA
- Get CTA of head and neck if not contraindicated, creatine normal.
- No antiplatelet (including aspirin), no anticoagulant for 24 hours
- Bed rest
- Keep BP <185/105
- Acetaminophen if temperature over 38 degree C
- Treat hyperglycemia to achieve a range of 140-180
- Avoid arterial puncture, Foley, NG if possible
- VTE prophylaxis with SCD
- Swallow eval, ST, PT, OT
- Order CT or MRI AT 24 hour post tpa, to check for bleed
- Document stroke type, more information.
Angioedema
- Occurs in 1-8 percent of patients
- Usually mild and transient.
- Discontinue tpa if still infusing and hold ACEI
- If only lips and anterior tongue involve, monitor closely
- If palate or pharynx are involved, may need intubation
- Medications:
- Methylprednisolone iv 125 mg
- Diphenhydramine 50 mg iv
- Ranitidine 50 mg or Famotidine 20 mg iv
- If further increase in angioedema: epinephrine 0.1% 0.3 ml sq or by nebulizer 0.5 ml
- Icatibant, a selective bradykinin B2 receptor antagonist, 3 mL (30 mg) sq in abdominal area. Additional injection of 30 mg may be given at intervals of 6 h not to exceed total of 3 injections in 24 h.
- Plasma-derived C1 esterase inhibitor (20 IU/kg) has been successfully used in hereditary angioedema and ACEI-related angioedema
CTA results:
- high grade stenosis or thrombosis at
- Carotid or Middle cerebral artery
- or other large artery