Post-tPA Hemorrhage in CVA: Difference between revisions

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Consider bleeding if decreased LOC, increased weakness, new headache, sudden rise in blood pressure.
Consider bleeding if decreased LOC, increased weakness, new headache, sudden rise in blood pressure


   
   


If bleeding occurs after tpa given,
If bleeding occurs after tPA:
 
1- stop tpa infusion
 
2- stat CT- if no bleeding, resume tpa.
 
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.


* Stop tpa infusion
* Stat head CT
* if no bleeding resume tpa
* If bleeding check labs, consider fibrinogen replacement
* Recheck pt/ptt, platelets, fibrinogen levels
* Prepare 6- 8 units cryoprecipitate
* Prepare 6- 8 units platelets
   
   


Revision as of 23:42, 1 March 2011

Consider bleeding if decreased LOC, increased weakness, new headache, sudden rise in blood pressure


If bleeding occurs after tPA:

  • Stop tpa infusion
  • Stat head CT
  • if no bleeding resume tpa
  • If bleeding check labs, consider fibrinogen replacement
  • Recheck pt/ptt, platelets, fibrinogen levels
  • Prepare 6- 8 units cryoprecipitate
  • Prepare 6- 8 units platelets


6/06 MISTRY

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