Acute Management and IV tPA for Ischemic Stroke
This audio segment covers the essential protocols for acute ischemic stroke management, focusing heavily on intravenous thrombolysis (IV tPA). It details the standard dosing regimen, crucial post-administration ICU care, strict eligibility time windows, and absolute contraindications, particularly focusing on bleeding risks and uncontrolled blood pressure parameters.
Duration
00:02:30
File size
1.52 MB
Practitioner-Guided Note
When evaluating a patient for IV tPA administration, strict adherence to blood pressure parameters (maintaining BP 1.7) before initiating the standard 0.9 mg/kg dose.
Key Takeaways
Standard tPA Dosing: 0.9 mg/kg (maximum 90 mg). Administer 10% as an initial bolus and infuse the remaining 90% over 1 hour.
Post-tPA Care Protocol: Patients require 24-hour ICU monitoring, maintaining blood pressure below 185/110, holding all antiplatelet medications, and repeating a CT scan at the 24-hour mark.
Treatment Window: The ideal administration window is within 3 hours of symptom onset, though it can be extended to 4.5 hours for eligible patients.
Major Contraindications: Do not administer if there is a history of intracranial hemorrhage, recent stroke (within 3 months), serious head trauma, recent intracranial surgery, or if clinical presentation suggests a subarachnoid hemorrhage.
Coagulopathy Risks: IV tPA is absolutely contraindicated if platelets are 1.7.