Warfarin associated bleeding
For serious bleeding Discontinue Warfarin Vit K 10 mg slow iv over 20-60 minutes may repeat q12 ir inr still high Kcentra: PCC (4 factor prothrombin complex concentrate) – 1500 to 2000 units iv over 10 min...
Intracerebral hemorrhage (ICH)
Intracerebral Hemorrhage (ICH) Score Initial care airway cardiovascular support acute stroke care facility, ICU care Reversal of anticoagulation & coagulopathy Stop all anticoagulant and antiplatelet Heparin associated bleed Protamine sulfate: slow IV infusion (< 20 mg/minute and no more than 50 mg over any 10-minute period). Warfarin associated ICH:...
Acute Stroke 1 – initial eval
History: sudden onset, Neuro deficit speech problem” repeat sentence, naming Facial droop weakness, check arm drift, rapid alternating movement, finger to nose Visual field, eye movement problem Onset: Get Time of Last known normal (LKN) from patient or family CT head stat: if it shows intracranial bleed Check glucose...
Status Epilepticus
Initial treatment Assess ABC, check lab: cmp, cbc, Tox screen, anticonvulsant levels Lorazepam 0.1 mg/kg or 4 mg iv at max of 2 mg/min Glucose + thiamine if indicated May need intubation Anticonvulsant loading Levetiracetam: 60 mg/kg, max 4500 mg over 15 minutes Valproate (Depacon): 30 mg/kg, at 10...
ICH – reverse anticoagulant
Received Vit K antagonist (Warfarin) If INR is above normal Use Vit K 10 mg iv, no faster than 1 mg/min, may repeat q 12 if inr remains high 4-factor PCC (Protrhmobin complex concentrate): Kcentra, better than fresh frozen plasma 1500 to 2000 IU at 100 IU/min If above...