Template:TPA Stroke: Difference between revisions

Revision as of 02:53, 29 September 2015

Alteplase

Dosing:

0.9mg/kg IV (max 90mg total)
- 10% of dose is administered as bolus; rest is given over 60min
Neuro check Q15min x 2hr
No anticoagulation/antiplatelets x 24hr
Blood pressure (keep SBP <180, DBP <105)

If SBP is >180-230 or DBP is >120:

Nicardipine 5 mg/hr by slow infusion (50 mL/hr) initially; may be increased by 2.5 mg/hr every 15 minutes; not to exceed 15 mg/hr OR
Labetalol 10mg IV over 1–2 min; repeat dose q10–20min up to 300mg max OR
Labetalol 10mg IV followed by infusion at 2–8 mg/min

If BP not controlled by above measures:

Nitroprusside 0.5–10mcg/kg/min
Continuous arterial monitoring advised
Use with caution in patients with hepatic or renal insufficiency

@@ Line 1: / Line 1: @@
-#Alteplase 0.9mg/kg IV (max 90mg total)
+===Alteplase===
-#*10% of dose is administered as bolus; rest is given over 60min
+Dosing:
-#Neuo check Q15min x 2hr
+*0.9mg/kg IV (max 90mg total)
-#No anticoagulation/antiplatelets x 24hr
+**10% of dose is administered as bolus; rest is given over 60min
-#Blood pressure (keep SBP <180, DBP <105)
+*Neuro check Q15min x 2hr
-#*If SBP is 180-230 or DBP is 105-120:
+*No anticoagulation/antiplatelets x 24hr
-#**[[Labetalol]] 10mg IV over 1–2 min; repeat dose q10–20min up to 300mg max OR
+*Blood pressure (keep SBP <180, DBP <105)
-#**[[Labetalol]] 10mg IV followed by infusion at 2–8 mg/min
+If SBP is >180-230 or DBP is >120:
-#*If SBP is >230 or DBP 121-140:
+*[[Nicardipine]] 5 mg/hr by slow infusion (50 mL/hr) initially; may be increased by 2.5 mg/hr every 15 minutes; not to exceed 15 mg/hr OR
-#**[[Labetalol]] as above OR [[nicardipine]] 5mg/hr; titrate up by 2.5 mg/hr at 5-15min intervals; max dose 15mg/hr
+*[[Labetalol]] 10mg IV over 1–2 min; repeat dose q10–20min up to 300mg max OR
-#*If BP not controlled by above measures:
+*[[Labetalol]] 10mg IV followed by infusion at 2–8 mg/min
-#**[[Nitroprusside]] 0.5–10mcg/kg/min
+If BP not controlled by above measures:
-#***Continuous arterial monitoring advised
+*[[Nitroprusside]] 0.5–10mcg/kg/min
-#***Use with caution in patients with hepatic or renal insufficiency
+*Continuous arterial monitoring advised
+*Use with caution in patients with hepatic or renal insufficiency