Acute Stroke 2 – consider TPA
Goal: Door to needle under 45 minutes (Time from arrival to TPA given) Tests: Absolutely needed CT head wo contrast to rule out bleed glucose > 50 Get the following but do not delay tpa O2 sat- BMP, CBC, INR, PTT troponin, ECG Consider TPA if: Significant neuro deficits: such...
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...
Nimodipine
Nimodipine 60 mg every four hours is administered to all patients with aneurysmal SAH within four days of SAH. Treatment is continued for 21 days....
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...