Goal:
Door to needle 60 minutes (Time from arrival to TPA given)
Consider TPA if:
Patient has significant neuro deficits: hemiparesis, speech problem, visual field loss, ataxia
Last known normal < 4.5 hours
History strongly suggestive of stroke, not other neuro problem
Most likely NOT TPA candidate:
= Patient with minimal Deficit, or symptoms resolved
= Not sure it is a stroke.
=Last known normal > 4.5 hours (not when stroke is found)
=TPA contraindicated for other reasons, such as elevated INR, on NOAC
= recent surgery, or other high risk of bleeding
Recommended tests for all acute ischemic stroke patients:
= oxygen saturation- BMP, CBC, INR, PTT
= troponin
= ECG
= CT head wo contrast
only CT head and a blood glucose must precede IV tPA administration except under special situations
If patient is a good candidate, give TPA
= DO NOT Delay
= Consider getting CTA of head and neck after tpa if Creatinine is normal
= If creat abnormal, CTA is not possible. CTA requires contrast.
= MRA is an option, MRA can be done without contrast.
Whether TPA is given or not
= If patient has a high grade stenosis of the Carotid, Basilar, Middle cerebral artery and is < 24 hours from Last known normal
= consider Stroke intervention therapy
= For patients who did not receive tPA, document reason
Full Reference online: http://www.medscape.com/viewarticle/779968
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