Difference between revisions of "Post-tPA Hemorrhage in CVA"

(Created page with "Consider bleeding if decreased LOC, increased weakness, new headache, sudden rise in blood pressure. If bleeding occurs after tpa given, 1- stop tpa infusion 2- stat CT- if...")
 
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Consider bleeding if decreased LOC, increased weakness, new headache, sudden rise in blood pressure.
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==Background==
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*Consider if patient develops:
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**Decreased LOC
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**Increased weakness
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**New headache
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**Sudden rise in BP
  
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==Management==
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*Stop tPA
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*Head CT
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**If no bleeding: resume tPA
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**If bleeding:
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***Consider fibrinogen replacement
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***Recheck CBC, coags fibrinogen levels
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***Prepare 6-8 units cryoprecipitate
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***Prepare 6-8 units platelets
  
If bleeding occurs after tpa given,
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==See Also==
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*[[CVA (tPA Criteria)]]
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*[[CVA (Main)]]
  
1- stop tpa infusion
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==References==
 
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<references/>
2- stat CT- if no bleeding, resume tpa.
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[[Category:Neurology]]
 
 
3- check new pt/ptt, platelets, fibrinogen lvls
 
 
 
4- prepare 6- 8 units cryoprcptte
 
 
 
5- prerare 6- 8 units platelets
 
 
 
6- if ICH present on CT, check labs and consider fibrinogen replacement
 
 
 
 
 
 
CVA GENERAL
 
 
 
- asa only. Heparin not help CVA- only possible TIA
 
 
 
- control BP <185/110 with labetolol 10mg iv
 
 
 
- CT scan might be negative if hyperacute
 
 
 
- hyperglycemia worsens outcome- no glucuse in fluids and use insulin prn
 
 
 
- no ASA if TPA to be given
 
 
 
- cardiac dysrrhythmia by increased symp tone, catechol release, decreased parasymp tone.
 
 
 
 
 
 
6/06 MISTRY
 
 
 
 
 
 
 
 
 
[[Category:Neuro]]
 

Latest revision as of 01:13, 24 July 2017

Background

  • Consider if patient develops:
    • Decreased LOC
    • Increased weakness
    • New headache
    • Sudden rise in BP

Management

  • Stop tPA
  • Head CT
    • If no bleeding: resume tPA
    • If bleeding:
      • Consider fibrinogen replacement
      • Recheck CBC, coags fibrinogen levels
      • Prepare 6-8 units cryoprecipitate
      • Prepare 6-8 units platelets

See Also

References