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Stroke

COURSE

 

Understand and Prevent Stroke

 

 

UNDERSTAND AND PREVENT STROKE COURSE

 

15. TPA - Relative contraindications

 Seizure at the onset of stroke – Patients with seizures was excluded from the initial studies of TPA because they made it difficult to assess how much of the neurologic deficit was due to the seizure and how much due to the stroke.

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16. Blood pressure control is very important to prevent complications

FOR DOCTORS ONLY!

Before treatment, the goal is <185/<110mm Hg. Labetalol (Trandate, Normodyne) 10–20mg IV or a nicardipine (Cardene) drip (start at 5 mg/h and titrate up to a maximum of 15 mg/h) may be given to lower the blood pressure.

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17. TPA Procedure

FAST!

Remember: time is brain. Best results occur with treatment started within 2 hours of symptom onset.

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18. TPA Dose

  • TPA 0.9 mg/kg up to a maximum of 90mg total.
  • 10% given as IV bolus over 1 minute.
  • Remaining 90% infused over 1 hour.
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19. TPA-Related Intracranial Hemorrhage: Management Protocol

Stop TPA infusion if still running.

Goal: fibrinogen level>100 mg/dL with cryoprecipitate.

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