Thrombolysis administration

Size: px
Start display at page:

Download "Thrombolysis administration"

Transcription

1 Thrombolysis administration Liz Mackey Stroke Nurse Practitioner Western Health Sunshine & Footscray Hospital, Melbourne

2 Thanks ASNEN committee members Skye Coote, Acute Stroke Nurse, Eastern Health (slide 5) Lizzie Dodd, Clinical Practice Consultant, Acute Stroke Unit Coordinator, The Queen Elizabeth Hospital, SA Health (slide 21) 2

3 Outline Pharmacology Inclusion / Exclusion criteria Administration 3

4 Fibrin and the clot Fibrin, the protein that forms the meshwork of the clot 4

5 What is tpa? Tissue plasminogen activator Fibrinolytic agent i.e. Clot Buster Activates plasminogen to form plasmin Plasmin lyses fibrin 5

6 Inclusion criteria Onset symptoms within hours at the time of treatment initiation Clinical diagnosis of ischaemic stroke causing measurable neurological deficits (impaired language, motor function, cognition and / or gaze, vision, or neglect). Patient able to undergo a CT (+/- perfusion) before t-pa administration CT scan findings compatible with ischaemic stroke Age > 18 years. 6

7 Exclusion criteria Absolute contraindications Patient should not receive thrombolysis: the risk of bleeding / complications is too great Relative contraindications Consider the overall picture and risk versus benefit Discuss with stroke / neurology consultant May need to discuss with other specialist consultant(s) 7

8 Exclusion criteria Thrombolysis should not be given if: Likely aetiology other than brain ischaemia. Evidence of acute or chronic intracranial haemorrhage on CT. Clinical presentation of subarachnoid haemorrhage even if the initial CT is normal. Coma or severe obtundation with fixed eye deviation and complete hemiplegia. Hypertension (systolic >185mmHg or diastolic > 110 mmhg) on repeated measures prior to administration of tpa without response to medication. Presumed septic embolus. Blood Glucose < 2.8 or > 22 mmol/l. Pre-existing neurological illness resulting in a Modified Rankin Scale Score of 3 or higher Other serious, advanced, or terminal illness that would impose a significant hazard to the patient if the intravenous tpa were initiated. 8

9 Exclusion criteria * Relative contraindications: Discuss with the on-call neurologist. Known hereditary or acquired haemorrhagic diathesis (Platelet count < /mm³, Activated Partial Thromboplastin Time (APTT) or Prothrombin Time (PT) greater than normal), or oral anticoagulant therapy with an International Normalised Ratio (INR) of >1.7. * Intracranial neoplasm that is terminal or would increase the risk of intracranial bleeding after the administration of thrombolytic therapy, or may confound neurological assessment. * History of stroke / serious head trauma / intracranial or intraspinal surgery within previous 90 days. * Past history of intracranial haemorrhage, subarachnoid haemorrhage, arteriovenous malformation or aneurysm.* 9

10 Exclusion criteria * Relative contraindications: Discuss with the on-call neurologist. Early infarct signs greater than 1/3 of the middle cerebral artery territory.* Seizure on presentation. * Myocardial Infarction (within 90 days) * Major surgery (within 14 days) or arterial puncture at non-compressible site (within 7 days). * Recent trauma (within 30 days) with internal injuries or ulcerative wounds. * Gastrointestinal or urinary tract haemorrhage (within 21 days). * Pregnancy or parturition within the previous 30 days. * 10

11 Administration dose Dose = weight based on mg / kg 0.9 mg/kg IV 10% = bolus, injected over 1-minute WITHIN one-minute start infusion Remaining 90% infused over 1 hour 100 kg: Administer 10% of total dose as initial bolus over 1 minute; THEN 0.81 mg/kg as continuous infusion over 60 min; not to exceed total dose of 90 mg >100 kg: total dose = 90mg Administer 9 mg (10% of 90 mg) as IV bolus over 1 min; THEN 81 mg as a continuous infusion over 60 min 11

12 Patient Weight (kg) Total 0.9mg/kg (mg) Vol. of 1mg/ml Alteplase Patient Weight (kg) Total 0.9mg/kg (mg) Vol. of 1mg/ml Alteplase 10% Bolus (ml) 90% Infusion (ml) 10% Bolus (ml) 90% Infusion ml) kg & over

13 Administration infusion options 1. Syringe driver Image 13

14 Administration infusion options 2. Pump 14

15 Image medimart.com Western Health protocol 15

16 Western Health infusion pump program 16

17 Cost of alteplase at Western Health 50mg = $ mg = $ image 17

18 18

19 19

20 Administration drawing up the tpa 20

21 Reactions Anaphylactoid reactions Rash Urticaria Bronchospasm Hypotension Shock Angioedema Angioedema: Rare (1-2%) but potentially life-threatening Angioedema assessment: Check tongue size at beginning of infusion. Repeat every 15 minutes until 30 mins after tpa infusion Look for signs of bilateral or unilateral tongue enlargement Look for other signs of allergy 21

22 Administration guidelines for first 24-hrs Time Line 0 hrs THROMBOLYSIS ADMINISTRATION GUIDELINES First 24 Hours 10% bolus given over 1 minute Remaining 90% given as an infusion over 1 hour Monitor BP & GCS every 15 min - BP should be < 185/110 mmhg to be eligible for Alteplase treatment If SBP > 185 mmhg or DBP > 110 mmhg follow protocol for hypertensive management 22

23 Administration guidelines for first 24-hrs 0 2hr 15 minutely Neuro/Vital signs including temp for 2 hours to commence infusion. Report SBP<100mmHg or >185mmHg and DBP > 110mmHg (ongoing) Manual BP cuffs should be used instead of automatic BP machines to avoid over-inflation and bruising as a result of this Internal and external bleeding assessment (ongoing) Strict FBC (ongoing) Risk Assessment falls prevention (ongoing) Avoid any invasive therapies during Alteplase administration. If stable, organise transfer to Acute Stroke Unit 23

24 Administration guidelines for first 24-hrs 2 6 hrs 6 hrs 6 10 hrs ½ hourly GCS & vital signs & 1/24 temps for 4 hours. All urine & faeces to be screened for blood Internal and external bleeding assessment ongoing Avoid cannulation, IDC/NGT insertion for six hours post tpa Risk Assessment falls prevention (ongoing) NO anti-coagulation / anti-platelet therapy for 24-hours Bloods: (CK, Troponin, clotting, FBE) 1 hourly GCS & vital signs for 4 hours Internal and external bleeding assessment ongoing Risk Assessment falls prevention (ongoing) 24

25 Administration guidelines for first 24-hrs hrs 2 hourly GCS & vital signs for 12 hours GIT assessment including Speech Pathology Assessment Nasogastric tube can now be inserted if required All urine to be screened for blood 12hrs Pathology (FBE, clotting profile) 22hrs + 4 hourly GCS & vital signs until review 25

26 26

Primary Stroke Center Acute Stroke Transfer Guidelines When to Consider a Transfer:

Primary Stroke Center Acute Stroke Transfer Guidelines When to Consider a Transfer: When to Consider a Transfer: Hemorrhagic Stroke Large volume intracerebral hematoma greater than 5cm on CT Concern for expanding hematoma Rapidly declining mental status, especially requiring intubation

More information

GUIDELINES FOR THE EARLY MANAGEMENT OF PATIENTS WITH ACUTE ISCHEMIC STROKE

GUIDELINES FOR THE EARLY MANAGEMENT OF PATIENTS WITH ACUTE ISCHEMIC STROKE 2018 UPDATE QUICK SHEET 2018 American Heart Association GUIDELINES FOR THE EARLY MANAGEMENT OF PATIENTS WITH ACUTE ISCHEMIC STROKE A Summary for Healthcare Professionals from the American Heart Association/American

More information

ACCESS CENTER:

ACCESS CENTER: ACCESS CENTER: 1-877-367-8855 Emergency Specialty Services: BRAIN ATTACK Criteria: Stroke symptom onset time less than 6 hours Referring Emergency Department Patient Information Data: Time last known normal:

More information

NURSING DEPARTMENT CRITICAL CARE POLICY MANUAL CRITICAL CARE PROTOCOLS. ACUTE CEREBROVASCULAR ACCIDENT TPA (ACTIVASE /alteplase) FOR THROMBOLYSIS

NURSING DEPARTMENT CRITICAL CARE POLICY MANUAL CRITICAL CARE PROTOCOLS. ACUTE CEREBROVASCULAR ACCIDENT TPA (ACTIVASE /alteplase) FOR THROMBOLYSIS NURSING DEPARTMENT CRITICAL CARE POLICY MANUAL CRITICAL CARE PROTOCOLS ACUTE CEREBROVASCULAR ACCIDENT TPA (ACTIVASE /alteplase) FOR THROMBOLYSIS I. Purpose : A. To reduce morbidity and mortality associated

More information

Thrombolysis for acute ischaemic stroke Rapid Assessment Protocol NORTHERN IRELAND Regional Protocol (Version 002 July 08)

Thrombolysis for acute ischaemic stroke Rapid Assessment Protocol NORTHERN IRELAND Regional Protocol (Version 002 July 08) Thrombolysis for acute ischaemic stroke Rapid Assessment Protocol NORTHERN IRELAND Regional Protocol (Version 002 July 08) Patient Details Time of onset? Capillary Blood glucose 2.8-22.2 mmol/l? Blood

More information

Thrombolysis Delivery, Care, and Monitoring. 5 Acute Trusts - 6 Primary Care Trusts Ambulance Trust 4 Local Authorities

Thrombolysis Delivery, Care, and Monitoring. 5 Acute Trusts - 6 Primary Care Trusts Ambulance Trust 4 Local Authorities Thrombolysis Delivery, Care, and Monitoring Documentation & Pathways Need to follow locally agreed policies and procedures Follow thrombolysis pathway? Need to complete Sits database Weight Dose matters!

More information

AGWS Stroke Thrombolysis Clinical Profoma

AGWS Stroke Thrombolysis Clinical Profoma AGWS Stroke Thrombolysis Clinical Profoma Incorporating Salisbury NHS Foundation Trust guidance Date: On Arrival: Affix patient label here) GCS NIHSS Score: Pulse SaO on Air Give O only if < 95 % on Air

More information

Stroke Transfer Checklist

Stroke Transfer Checklist Stroke Transfer Checklist When preparing to transfer an acute stroke patient to the UF Health Shands Comprehensive Stroke Center, please make every attempt to include the following information: Results

More information

CLINICAL GUIDELINES ID TAG

CLINICAL GUIDELINES ID TAG Title: Author: Speciality/ Division: Directorate: Date Uploaded: Review Date: September 2019 CG ID TAG CG0423 CLINICAL GUIDELINES ID TAG Clinical Guideline for Alteplase in intra-arterial thrombolysis

More information

Updated Ischemic Stroke Guidelines นพ.ส ชาต หาญไชยพ บ ลย ก ล นายแพทย ทรงค ณว ฒ สาขาประสาทว ทยา สถาบ นประสาทว ทยา กรมการแพทย กระทรวงสาธารณส ข

Updated Ischemic Stroke Guidelines นพ.ส ชาต หาญไชยพ บ ลย ก ล นายแพทย ทรงค ณว ฒ สาขาประสาทว ทยา สถาบ นประสาทว ทยา กรมการแพทย กระทรวงสาธารณส ข Updated Ischemic Stroke Guidelines นพ.ส ชาต หาญไชยพ บ ลย ก ล นายแพทย ทรงค ณว ฒ สาขาประสาทว ทยา สถาบ นประสาทว ทยา กรมการแพทย กระทรวงสาธารณส ข Emergency start at community level: Prehospital care Acute stroke

More information

Thrombolytic therapy should be the first line treatment in acute ishchemic stroke. We are against it!!

Thrombolytic therapy should be the first line treatment in acute ishchemic stroke. We are against it!! Thrombolytic therapy should be the first line treatment in acute ishchemic stroke We are against it!! 85% of strokes are ischaemic, and related to blockage of an artery by a blood clot, so potential treatments

More information

Journal Club. 1. Develop a PICO (Population, Intervention, Comparison, Outcome) question for this study

Journal Club. 1. Develop a PICO (Population, Intervention, Comparison, Outcome) question for this study Journal Club Articles for Discussion Tissue plasminogen activator for acute ischemic stroke. The National Institute of Neurological Disorders and Stroke rt-pa Stroke Study Group. N Engl J Med. 1995 Dec

More information

o Unenhanced Head CT

o Unenhanced Head CT Drip & Ship Protocol Acute Stroke Ready Hospital (ASRH) Duluth Area Primary Stroke Center (St. Luke s & St. Mary s Essentia) PATIENT LABEL Patient displays strokelike symptoms EMS/ED CSS > 0 Glucose >

More information

Canadian Stroke Best Practices Initial ED Evaluation of Acute Stroke and Transient Ischemic Attack (TIA) Order Set (Order Set 1)

Canadian Stroke Best Practices Initial ED Evaluation of Acute Stroke and Transient Ischemic Attack (TIA) Order Set (Order Set 1) Canadian Best Practice Recommendations for Stroke Care: All patients presenting to an emergency department with suspected stroke or transient ischemic attack must have an immediate clinical evaluation

More information

Thrombolysis Assessment

Thrombolysis Assessment Thrombolysis Assessment Brief Clinical Summary of symptom onset of arrival of patient of assessment BP GCS BM If BM

More information

Acute Stroke Protocols Modified- What s New in 2013

Acute Stroke Protocols Modified- What s New in 2013 Acute Stroke Protocols Modified- What s New in 2013 KUMAR RAJAMANI, MD, DM. Vascular Neurologist-MSN Associate Professor of Neurology WSU School of Medicine. Saturday, September 21, 2013 Crystal Mountain

More information

Primary Stroke Center Quality & Performance Measures

Primary Stroke Center Quality & Performance Measures Primary Stroke Center Quality & Performance Measures This section of the manual contains information related to the quality performance of Primary Stroke Centers. Brain Attack Coalition Definitions Recognition

More information

NURSING DEPARTMENT CRITICAL CARE POLICY MANUAL CRITICAL CARE PROTOCOLS. ACTIVASE (t-pa) INFUSION PROTOCOL FOR ACUTE MYOCARDIAL INFARCTION

NURSING DEPARTMENT CRITICAL CARE POLICY MANUAL CRITICAL CARE PROTOCOLS. ACTIVASE (t-pa) INFUSION PROTOCOL FOR ACUTE MYOCARDIAL INFARCTION NURSING DEPARTMENT CRITICAL CARE POLICY MANUAL CRITICAL CARE PROTOCOLS ACTIVASE (t-pa) FOR ACUTE MYOCARDIAL INFARCTION I. PURPOSE: A. To reduce the extent of myocardial infarction by lysing the clot in

More information

ACUTE ISCHEMIC STROKE. Current Treatment Approaches for Acute Ischemic Stroke

ACUTE ISCHEMIC STROKE. Current Treatment Approaches for Acute Ischemic Stroke ACUTE ISCHEMIC STROKE Current Treatment Approaches for Acute Ischemic Stroke EARLY MANAGEMENT OF ACUTE ISCHEMIC STROKE Rapid identification of a stroke Immediate EMS transport to nearest stroke center

More information

Comparison of Five Major Recent Endovascular Treatment Trials

Comparison of Five Major Recent Endovascular Treatment Trials Comparison of Five Major Recent Endovascular Treatment Trials Sample size 500 # sites 70 (100 planned) 316 (500 planned) 196 (833 estimated) 206 (690 planned) 16 10 22 39 4 Treatment contrasts Baseline

More information

Nursing Management Pre /Post Thrombolysis in Stroke

Nursing Management Pre /Post Thrombolysis in Stroke Craigavon Area Hospital Guidelines for Nursing Management Pre /Post Thrombolysis in Stroke 1. A senior nurse in the stroke unit will be required to monitor the patients condition post Thrombolysis on a

More information

The Multi arm Optimization of Stroke Thrombolysis (MOST) Trial

The Multi arm Optimization of Stroke Thrombolysis (MOST) Trial The Multi arm Optimization of Stroke Thrombolysis (MOST) Trial Study Team Principal Investigators: Opeolu Adeoye, University of Cincinnati (Lead) Andrew Barreto, University of Texas Houston Jim Grotta,

More information

Department Specific Guideline

Department Specific Guideline Department Specific Guideline Stroke/TIA Management ED Applicable to: Nursing/Medical staff caring Authorised by: Stroke services team for Acute stroke/tia patients Contact person: Clinical nurse manager,

More information

Dr Ben Turner. Consultant Neurologist and Honorary Senior Lecturer Barts and The London NHS Trust London Bridge Hospital

Dr Ben Turner. Consultant Neurologist and Honorary Senior Lecturer Barts and The London NHS Trust London Bridge Hospital Stroke Management Dr Ben Turner Consultant Neurologist and Honorary Senior Lecturer Barts and The London NHS Trust London Bridge Hospital Introduction Stroke is the major cause of disability in the developed

More information

ST Elevation Myocardial Infarction (STEMI) Reperfusion Order Set

ST Elevation Myocardial Infarction (STEMI) Reperfusion Order Set Form Title Form Number CH-0454 2018, Alberta Health Services, CKCM This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License. The license does not

More information

Emergency Room Procedure The first few hours in hospital...

Emergency Room Procedure The first few hours in hospital... Emergency Room Procedure The first few hours in hospital... ER 5 level Emergency Severity Index SOP s for Stroke Stroke = Level 2 Target Time = 1 Hour 10 min from door 2 Doctor 25 min from door 2 CT 60

More information

Protocol for IV rtpa Treatment of Acute Ischemic Stroke

Protocol for IV rtpa Treatment of Acute Ischemic Stroke Protocol for IV rtpa Treatment of Acute Ischemic Stroke Acute stroke management is progressing very rapidly. Our team offers several options for acute stroke therapy, including endovascular therapy and

More information

Stroke in the ED. Dr. William Whiteley. Scottish Senior Clinical Fellow University of Edinburgh Consultant Neurologist NHS Lothian

Stroke in the ED. Dr. William Whiteley. Scottish Senior Clinical Fellow University of Edinburgh Consultant Neurologist NHS Lothian Stroke in the ED Dr. William Whiteley Scottish Senior Clinical Fellow University of Edinburgh Consultant Neurologist NHS Lothian 2016 RCP Guideline for Stroke RCP guidelines for acute ischaemic stroke

More information

Transfusion Requirements and Management in Trauma RACHEL JACK

Transfusion Requirements and Management in Trauma RACHEL JACK Transfusion Requirements and Management in Trauma RACHEL JACK Overview Haemostatic resuscitation Massive Transfusion Protocol Overview of NBA research guidelines Haemostatic resuscitation Permissive hypotension

More information

ENDOVASCULAR THERAPIES FOR ACUTE STROKE

ENDOVASCULAR THERAPIES FOR ACUTE STROKE ENDOVASCULAR THERAPIES FOR ACUTE STROKE Cerebral Arteriogram Cerebral Anatomy Cerebral Anatomy Brain Imaging Acute Ischemic Stroke (AIS) Therapy Main goal is to restore blood flow and improve perfusion

More information

Page 1 of 7. Intraparenchymal hemorrhage or subarachnoid hemorrhage. Consult neurosurgery

Page 1 of 7. Intraparenchymal hemorrhage or subarachnoid hemorrhage. Consult neurosurgery Management of Acute Ischemic Stroke in Adult Patients INITIAL ASSESSMENT Look for signs and symptoms of stroke (see Appendix A) STAT finger stick glucose STAT 12-lead EKG Inform radiology that patient

More information

Management of Acute Myocardial Infarction

Management of Acute Myocardial Infarction Management of Acute Myocardial Infarction Prof. Hossam Kandil Professor of Cardiology Cairo University ST Elevation Acute Myocardial Infarction Aims Of Management Emergency care (Pre-hospital) Early care

More information

When the learner has completed this module, she/he will be able to:

When the learner has completed this module, she/he will be able to: Thrombolytics and Myocardial Infarction WWW.RN.ORG Reviewed September 2017, Expires September 2019 Provider Information and Specifics available on our Website Unauthorized Distribution Prohibited 2017

More information

ST Elevated Myocardial Infarction- Latest AHA recommendations

ST Elevated Myocardial Infarction- Latest AHA recommendations ST Elevated Myocardial Infarction- Latest AHA recommendations Sherry Turner, DO, MPH, FACOEP Medical Director Emergency Services Wesley Medical Center The Problem 250,000 Americans each year 30% fail to

More information

Emergency Department Management of Acute Ischemic Stroke

Emergency Department Management of Acute Ischemic Stroke Emergency Department Management of Acute Ischemic Stroke R. Jason Thurman, MD Associate Professor of Emergency Medicine and Neurosurgery Associate Director, Vanderbilt Stroke Center Vanderbilt University,

More information

ENCHANTED Era: Is it time to rethink treatment of acute ischemic stroke? Kristin J. Scherber, PharmD, BCPS Emergency Medicine Clinical Pharmacist

ENCHANTED Era: Is it time to rethink treatment of acute ischemic stroke? Kristin J. Scherber, PharmD, BCPS Emergency Medicine Clinical Pharmacist ENCHANTED Era: Is it time to rethink treatment of acute ischemic stroke? Kristin J. Scherber, PharmD, BCPS Emergency Medicine Clinical Pharmacist Pharmacy Grand Rounds 26 July 2016 2015 MFMER slide-1 Learning

More information

11/27/2017. Stroke Management in the Neurocritical Care Unit. Conflict of interest. Karel Fuentes MD Medical Director of Neurocritical Care

11/27/2017. Stroke Management in the Neurocritical Care Unit. Conflict of interest. Karel Fuentes MD Medical Director of Neurocritical Care Stroke Management in the Neurocritical Care Unit Karel Fuentes MD Medical Director of Neurocritical Care Conflict of interest None Introduction Reperfusion therapy remains the mainstay in the treatment

More information

Emergency Treatment of Ischemic Stroke

Emergency Treatment of Ischemic Stroke Emergency Treatment of Ischemic Stroke JEFFREY BOYLE, M.D., PHD CLINICAL DIRECTOR OF STROKE AT AVERA MCKENNAN AVERA MEDICAL GROUP NEUROLOGY SIOUX FALLS, SD Conflicts of Interest None I will discuss therapies

More information

Acute Stroke with Alteplase Administration Order Set

Acute Stroke with Alteplase Administration Order Set Review Due Date: 2017 October PATIENT CARE DERS Weight: Adverse Reactions or Intolerances Drug No Yes (list) Food No Yes (list) _ Latex No Yes Admission Admit to Neurology service: Dr. Critical Care Diagnosis:

More information

Unclogging The Pipes. Zahraa Rabeeah MD Chief Resident February 9,2018

Unclogging The Pipes. Zahraa Rabeeah MD Chief Resident February 9,2018 Unclogging The Pipes Zahraa Rabeeah MD Chief Resident February 9,2018 Please join Polleverywhere by texting: ZRABEEAH894 to 37607 Disclosures None Objectives Delineate the differences between TPA vs thrombectomy

More information

PE Pathway. The charts are listed as follows:

PE Pathway. The charts are listed as follows: PE Pathway This document comprises 6 simple flow charts to assist clinicians in the investigation and treatment of suspected or confirmed Acute Pulmonary Emboli. The pathway has been put together using

More information

Shawke A. Soueidan, MD. Riverside Neurology & Sleep Specialists

Shawke A. Soueidan, MD. Riverside Neurology & Sleep Specialists Shawke A. Soueidan, MD Riverside Neurology & Sleep Specialists 757-221-0110 Epidemiology of stroke 2018 Affects nearly 800,000 people in the US annually Approximately 600000 first-ever strokes and 185000

More information

How to give thrombolysis in acute myocardial infarction

How to give thrombolysis in acute myocardial infarction Page 1 of 6 How to give thrombolysis in acute myocardial infarction Original article: Michael Tam In the major urban hospitals, there will be little place for thrombolysis in acute STEMI (STelevation myocardial

More information

2018 Early Management of Acute Ischemic Stroke Guidelines Update

2018 Early Management of Acute Ischemic Stroke Guidelines Update 2018 Early Management of Acute Ischemic Stroke Guidelines Update Brandi Bowman, PhC, Pharm.D. April 17, 2018 Pharmacist Objectives Describe the recommendations for emergency medical services and hospital

More information

Disclosures. Outline. Updated Recommendations for Using Alteplase (TPA) in Acute Ischemic Stroke

Disclosures. Outline. Updated Recommendations for Using Alteplase (TPA) in Acute Ischemic Stroke Updated Recommendations for Using Alteplase (TPA) in Acute Ischemic Stroke Mark J. Alberts, MD, FAHA Chief of Neurology Hartford Hospital Hartford, CT Disclosures Dr. Alberts is a speaker and consultant

More information

Updated tpa Guidelines: Expanding the opportunity for good outcomes. Benjamin Morrow, MSN RN UPMC Stroke Institute

Updated tpa Guidelines: Expanding the opportunity for good outcomes. Benjamin Morrow, MSN RN UPMC Stroke Institute Updated tpa Guidelines: Expanding the opportunity for good outcomes Benjamin Morrow, MSN RN UPMC Stroke Institute 1 Outline History Current State Review Exclusions: Minor stroke symptoms Severe strokes

More information

ADVERSE REACTIONS The most frequently occurring adverse reaction ( > 5%) is bleeding.

ADVERSE REACTIONS The most frequently occurring adverse reaction ( > 5%) is bleeding. HIGHLIGHTS OF PRESCRIBING INFORMATION These highlights do not include all the information needed to use ACTIVASE safely and effectively. See full prescribing information for ACTIVASE. Activase (alteplase)

More information

Operation Stroke. How to Reduce the Risk of Stroke Complications

Operation Stroke. How to Reduce the Risk of Stroke Complications Operation Stroke How to Reduce the Risk of Stroke Complications Objectives Focus on Acute Stroke as an active disease Discuss the most common stroke complications Describe how first 72 hours sets the stage

More information

Pathophysiology of stroke

Pathophysiology of stroke A practical approach to acute stro ke Dr. Sanjith Aaron, M.D., D.M., Professor, Department of Neurosciences, CMC Vellore Stroke is characterized by an abrupt onset of neurological deficit lasting more

More information

Complications of Thrombolysis

Complications of Thrombolysis Complications of Thrombolysis David H. Jang, M.D. Lewis S. Nelson, M.D. Case Summary: An 88 year-old man with a past medical history of hypertension and paroxysmal atrial fibrillation presented to the

More information

Acute stroke thrombolysis with intravenous tissue plasminogen activator in an Australian tertiary hospital

Acute stroke thrombolysis with intravenous tissue plasminogen activator in an Australian tertiary hospital Acute stroke thrombolysis with intravenous tissue plasminogen activator in an Australian tertiary hospital STROKE IS THE MOST common cause of permanent disability in the Australian community The Medical

More information

9/24/2013. Thrombolytics in 2013: Never Say Never. September 19 th, 2013 Scott M Lilly, MD PhD. Clinical Case

9/24/2013. Thrombolytics in 2013: Never Say Never. September 19 th, 2013 Scott M Lilly, MD PhD. Clinical Case September 19 th, 2013 Scott M Lilly, MD PhD Thrombolytics in 2013: Never Say Never Clinical Case 2 1 Evolution of STEMI Therapy The importance of absolute rest in bed for several days is clear James B

More information

SUMMARY OF PRODUCT CHARACTERISTICS

SUMMARY OF PRODUCT CHARACTERISTICS SUMMARY OF PRODUCT CHARACTERISTICS 1 1. NAME OF THE MEDICINAL PRODUCT Actilyse Powder and solvent for solution for injection and infusion 2. QUALITATIVE AND QUANTITATIVE COMPOSITION 1 vial with powder

More information

Diagnosis and Management of Acute Myocardial Infarction

Diagnosis and Management of Acute Myocardial Infarction Diagnosis and Management of Acute Myocardial Infarction Acute Myocardial Infarction (AMI) occurs as a result of prolonged myocardial ischemia Atherosclerosis leads to endothelial rupture or erosion that

More information

Tony L Smith DNP RN ACNP CCRN CFRN EMT-IV Vanderbilt LifeFlight

Tony L Smith DNP RN ACNP CCRN CFRN EMT-IV Vanderbilt LifeFlight Treatment of a Stroke patient: A look at how to care for the Stroke patient in the aeromedical setting Tony L Smith DNP RN ACNP CCRN CFRN EMT-IV Vanderbilt LifeFlight Objectives 1. Discuss the assessment

More information

www.yassermetwally.com MANAGEMENT OF CEREBRAL HAEMORRHAGE (ICH): A QUICK GUIDE Overview 10% of strokes is caused by ICH. Main Causes: Less than 40 years old: vascular malformations and illicit drug use.

More information

Blood Pressure Management in Acute Ischemic Stroke

Blood Pressure Management in Acute Ischemic Stroke Blood Pressure Management in Acute Ischemic Stroke Kimberly Clark, PharmD, BCCCP Clinical Pharmacy Specialist Critical Care, Greenville Health System Adjunct Assistant Professor, South Carolina College

More information

TIA AND STROKE. Topics/Order of the day 1. Topics/Order of the day 2 01/08/2012

TIA AND STROKE. Topics/Order of the day 1. Topics/Order of the day 2 01/08/2012 Charles Ashton Medical Director TIA AND STROKE Topics/Order of the day 1 What Works? Clinical features of TIA inc the difference between Carotid and Vertebral territories When is a TIA not a TIA TIA management

More information

Considering Activase (alteplase) for treatment of acute ischemic stroke

Considering Activase (alteplase) for treatment of acute ischemic stroke Considering Activase (alteplase) for treatment of acute ischemic stroke A DISCUSSION GUIDE FOR PATIENTS AND CAREGIVERS Indication Activase (alteplase) is indicated for treating patients with acute ischemic

More information

Stroke: The First Critical Hour. Alina Candal, RN, PCC, MICN Kevin Andruss, MD, FACEP

Stroke: The First Critical Hour. Alina Candal, RN, PCC, MICN Kevin Andruss, MD, FACEP Stroke: The First Critical Hour Alina Candal, RN, PCC, MICN Kevin Andruss, MD, FACEP Disclosures We have no actual or potential conflicts of interest in relation to this presentation. Objectives Discuss

More information

Mercy University Hospital Stroke Service. Protocol for IV Thrombolysis for cerebral infarction

Mercy University Hospital Stroke Service. Protocol for IV Thrombolysis for cerebral infarction Mercy University Hospital Stroke Service. Protocol for IV Thrombolysis for cerebral infarction March 7 th 2008 Preamble Following on recent discussions exploring the possibility of administering thrombolysis

More information

Administering Intravenous Alteplase (Tissue Plasminogen Activator [tpa])

Administering Intravenous Alteplase (Tissue Plasminogen Activator [tpa]) Administering Intravenous Alteplase (Tissue Plasminogen Activator [tpa]) Step 1: Eligibility---The eligibility criteria for patients with acute ischemic stroke within 3 hours of symptom onset include:

More information

Guideline scope Stroke and transient ischaemic attack in over 16s: diagnosis and initial management (update)

Guideline scope Stroke and transient ischaemic attack in over 16s: diagnosis and initial management (update) NATIONAL INSTITUTE FOR HEALTH AND CARE EXCELLENCE Guideline scope Stroke and transient ischaemic attack in over s: diagnosis and initial management (update) 0 0 This will update the NICE on stroke and

More information

Sepsis Early Recognition and Management. Therese Hughes, PhD, MPA, RN

Sepsis Early Recognition and Management. Therese Hughes, PhD, MPA, RN Sepsis Early Recognition and Management Therese Hughes, PhD, MPA, RN 1 Sepsis a Deadly Progression Affects millions around the world each year, killing one in four Contributes to approximately 50% of all

More information

Acute Management of Pulmonary Embolism

Acute Management of Pulmonary Embolism Acute Management of Pulmonary Embolism Dr Alex West Respiratory Consultant Guy s and St Thomas Hospital London Declarations - none Order of Play Up date in Diagnostic Imaging - CTPA and V:Q SPECT Sub-massive

More information

Stroke Update. Lacunar 19% Thromboembolic 6% SAH 13% ICH 13% Unknown 32% Hemorrhagic 26% Ischemic 71% Other 3% Cardioembolic 14%

Stroke Update. Lacunar 19% Thromboembolic 6% SAH 13% ICH 13% Unknown 32% Hemorrhagic 26% Ischemic 71% Other 3% Cardioembolic 14% Stroke Update Michel Torbey, MD, MPH, FAHA, FNCS Medical Director, Neurovascular Stroke Center Professor Department of Neurology and Neurosurgery The Ohio State University Wexner Medical Center Objectives

More information

ANNEX I SUMMARY OF PRODUCT CHARACTERISTICS

ANNEX I SUMMARY OF PRODUCT CHARACTERISTICS ANNEX I SUMMARY OF PRODUCT CHARACTERISTICS 1 1. NAME OF THE MEDICINAL PRODUCT Tenecteplase Boehringer Ingelheim Pharma KG 6,000 units Powder and solvent for solution for injection 2. QUALITATIVE AND QUANTITATIVE

More information

PRACTICE GUIDELINE. DEFINITIONS: Mild head injury: Glasgow Coma Scale* (GCS) score Moderate head injury: GCS 9-12 Severe head injury: GCS 3-8

PRACTICE GUIDELINE. DEFINITIONS: Mild head injury: Glasgow Coma Scale* (GCS) score Moderate head injury: GCS 9-12 Severe head injury: GCS 3-8 PRACTICE GUIDELINE Effective Date: 9-1-2012 Manual Reference: Deaconess Trauma Services TITLE: TRAUMATIC BRAIN INJURY GUIDELINE OBJECTIVE: To provide practice management guidelines for traumatic brain

More information

Thrombolysis, adjunctive pharmacology and interventions

Thrombolysis, adjunctive pharmacology and interventions ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation ESC Annual Congress Munich, 2012 Thrombolysis, adjunctive pharmacology and interventions

More information

Interventional Neuroradiology. & Stroke INR PROCEDURES INR PROCEDURES. Dr Steve Chryssidis. 25-Sep-17. Interventional Neuroradiology

Interventional Neuroradiology. & Stroke INR PROCEDURES INR PROCEDURES. Dr Steve Chryssidis. 25-Sep-17. Interventional Neuroradiology Interventional Neuroradiology Interventional Neuroradiology & Stroke Dr Steve Chryssidis Interventional Neuroradiology (INR) is a subspecialty within Radiology INR -- broadly defined as treatment by endovascular

More information

Guideline for Thrombolysis Therapy in Pulmonary Embolism

Guideline for Thrombolysis Therapy in Pulmonary Embolism Guideline for Thrombolysis Therapy in Pulmonary Embolism Dr Jane Strong Consultant Haematologist Trust ref: B24/2016 1. Introduction / Scope All Patients with pulmonary embolism (PE) require rapid risk

More information

Anticoagulants. Pathological formation of a haemostatic plug Arterial associated with atherosclerosis Venous blood stasis e.g. DVT

Anticoagulants. Pathological formation of a haemostatic plug Arterial associated with atherosclerosis Venous blood stasis e.g. DVT Haemostasis Thrombosis Phases Endogenous anticoagulants Stopping blood loss Pathological formation of a haemostatic plug Arterial associated with atherosclerosis Venous blood stasis e.g. DVT Vascular Platelet

More information

Epidemiology: Incidence VTE: Mortality Morbidity Risk Factors: Acute Chronic : Genetic

Epidemiology: Incidence VTE: Mortality  Morbidity Risk Factors: Acute Chronic : Genetic Submassive PE Pulmonary Embolism Epidemiology: Incidence VTE: 100-200/100,000 = 3rd most frequent cardiovascular disease Symptomatic DVT complicated by PE = 40-50% Sudden fatal PE = 34% Intermediate-risk

More information

ED Stroke Panel Page 1 of 2

ED Stroke Panel Page 1 of 2 ED Stroke Panel Page 1 of 2 Reference EMMC *************************Usec: Call Operator to page a Stroke Alert ********************** Laboratory Bedside Glucose Monitoring ONCE Notify provider if glucose

More information

Effectiveness and cost-effectiveness of thrombolysis in submassive pulmonary embolism Perlroth D J, Sanders G D, Gould M K

Effectiveness and cost-effectiveness of thrombolysis in submassive pulmonary embolism Perlroth D J, Sanders G D, Gould M K Effectiveness and cost-effectiveness of thrombolysis in submassive pulmonary embolism Perlroth D J, Sanders G D, Gould M K Record Status This is a critical abstract of an economic evaluation that meets

More information

Pharmacy STROKE. Anne Kinnear Lead Pharmacist NHS Lothian. Educational Solutions for Workforce Development

Pharmacy STROKE. Anne Kinnear Lead Pharmacist NHS Lothian. Educational Solutions for Workforce Development STROKE Anne Kinnear Lead Pharmacist NHS Lothian Aim To update pharmacists on Stroke: the disease and its management and explore ways to implement pharmaceutical care for this patient group as part of normal

More information

Stroke in the Emergency Room: What do we need to know?

Stroke in the Emergency Room: What do we need to know? Stroke in the Emergency Room: What do we need to know? Salah G. Keyrouz, MD, FAHA March 10, 2012 Stroke in the Emergency Room: What do we need to know? Disclosure: None 2 1 Outline Definition Introduction

More information

RETAVASE (reteplase) for injection, for intravenous use Initial U.S. Approval: 1996

RETAVASE (reteplase) for injection, for intravenous use Initial U.S. Approval: 1996 HIGHLIGHTS OF PRESCRIBING INFORMATION These highlights do not include all the information needed to use RETAVASE safely and effectively. See full prescribing information for RETAVASE. RETAVASE (reteplase)

More information

Review of the TICH-2 Trial

Review of the TICH-2 Trial Review of the TICH-2 Trial Mikaela Hofer, PharmD PGY-1 Pharmacy Resident Pharmacy Grand Rounds September 18, 2018 2018 MFMER slide-1 Objectives Review the pharmacologic options to limit hematoma expansion

More information

* * FORM REV. 02/2019 Page 1 of 4. TNKASE (tenecteplase) / ACUTE STEMI ORDERS SCHEDULED MEDICATIONS:

* * FORM REV. 02/2019 Page 1 of 4. TNKASE (tenecteplase) / ACUTE STEMI ORDERS SCHEDULED MEDICATIONS: 1. Is this a CMS inpatient only procedure? Yes, admit as inpatient, proceed to # 3 No, proceed to # 2 2. Do you expect that the patient s condition will require a hospital stay that will cross two midnights

More information

Standardize comprehensive care of the patient with severe traumatic brain injury

Standardize comprehensive care of the patient with severe traumatic brain injury Trauma Center Practice Management Guideline Iowa Methodist Medical Center Des Moines Management of Patients with Severe Traumatic Brain Injury (GCS < 9) ADULT Practice Management Guideline Contact: Trauma

More information

Building a Stroke Portfolio. June 28, 2018

Building a Stroke Portfolio. June 28, 2018 Building a Stroke Portfolio June 28, 2018 1 Forward-Looking Statements This presentation contains forward-looking statements, including statements relating to: the potential benefits, safety and efficacy

More information

Blood Thinner Agent. Done by: Meznah Al-mutairi Pharm.D Candidate PNU Collage of Pharmacy

Blood Thinner Agent. Done by: Meznah Al-mutairi Pharm.D Candidate PNU Collage of Pharmacy Blood Thinner Agent Done by: Meznah Al-mutairi Pharm.D Candidate PNU Collage of Pharmacy Outline: Blood thinner agent definition. anticoagulants drugs. Thrombolytics. Blood thinner agent Therapeutic interference

More information

When Not To Give TPA Steve Phillips Division of Neurology

When Not To Give TPA Steve Phillips Division of Neurology When Not To Give TPA Steve Phillips Division of Neurology stephen.phillips@nshealth.ca AstraZeneca Disclosures - 1 I have given CME lectures and served on advisory boards for Boehringer Ingelheim Bristol-Myers

More information

NUH Emergency Department. Guideline for Diagnosis & Treatment of PE (Massive and Non-Massive) in Adults only

NUH Emergency Department. Guideline for Diagnosis & Treatment of PE (Massive and Non-Massive) in Adults only NUH Emergency Department Guideline for Diagnosis & Treatment of PE (Massive and n-massive) in Adults only Contents Suspected Pulmonary Embolus in the ED Flow Chart Page 1 Administration of Thrombolysis

More information

ANTICOAGULATION RELATED BLEEDING - GUIDELINE SUMMARY

ANTICOAGULATION RELATED BLEEDING - GUIDELINE SUMMARY ANTICOAGULATION RELATED BLEEDING - GUIDELINE SUMMARY Click here for the full Thrombosis Prevention Investigation and Management of Anticoagulation Guideline Click on the appropriate link below: o START

More information

SAH READMISSIONS TO NCCU

SAH READMISSIONS TO NCCU SAH READMISSIONS TO NCCU Are they preventable? João Amaral Rebecca Gorf Critical Care Outreach Team - NHNN 2015 Total admissions to NCCU =862 Total SAH admitted to NCCU= 104 (93e) (12.0%) Total SAH readmissions=

More information

Is Thrombolysis Only for a Crisis?

Is Thrombolysis Only for a Crisis? Is Thrombolysis Only for a Crisis? December 19, 2017 Is Thrombolysis Only for a Crisis? Indications for Thrombolytic Therapy in Patients with Acute Pulmonary Embolism Case Scenario A 28 year old woman

More information

NIHSS. Category Scale Definition Date/Time Date/Time Date/Time. Score Initial. Drip & Ship Protocol. Initials: Signature: Initials: Signature:

NIHSS. Category Scale Definition Date/Time Date/Time Date/Time. Score Initial. Drip & Ship Protocol. Initials: Signature: Initials: Signature: NIHSS 1a. Level of Consciousness (Alert, drowsy, etc.) Category Scale Definition Date/Time Date/Time Date/Time 1b. LOC Question (Month, age) 1c. LOC Commands (Open, close eyes, make fist, let go) 2. Best

More information

Guidance for management of bleeding in patients taking the new oral anticoagulant drugs: rivaroxaban, dabigatran or apixaban

Guidance for management of bleeding in patients taking the new oral anticoagulant drugs: rivaroxaban, dabigatran or apixaban Guidance for management of bleeding in patients taking the new oral anticoagulant drugs: rivaroxaban, dabigatran or apixaban Purpose The aim of this guidance is to outline the management of patients presenting

More information

BECLOT 500MG. INJECTION Composition : Each ml. contains : Tranexamic Acid I.P. 100mg.

BECLOT 500MG. INJECTION Composition : Each ml. contains : Tranexamic Acid I.P. 100mg. BECLOT 500MG. INJECTION Composition : Each ml. contains : Tranexamic Acid I.P. 100mg. DESCRIPTION Tranexamic acid is a synthetic analog of the amino acid lysine. It is used to treat or prevent excessive

More information

BEAUMONT HOSPITAL. Beaumont Hospital Department of Nephrology and Renal Nursing ADMINISTRATION OF ACTILYSE. Guideline Number: 13. Guideline Version: B

BEAUMONT HOSPITAL. Beaumont Hospital Department of Nephrology and Renal Nursing ADMINISTRATION OF ACTILYSE. Guideline Number: 13. Guideline Version: B BEAUMONT HOSPITAL Beaumont Hospital Department of Nephrology and Renal Nursing Guideline Name: GUIDELINES FOR THE ADMINISTRATION OF ACTILYSE Guideline Number: 13 Guideline Version: B Developed By: Betty

More information

NURSING DEPARTMENT CRITICAL CARE POLICY MANUAL CRITICAL CARE PROTOCOLS EPTIFIBATIDE (INTEGRILIN) PROTOCOL

NURSING DEPARTMENT CRITICAL CARE POLICY MANUAL CRITICAL CARE PROTOCOLS EPTIFIBATIDE (INTEGRILIN) PROTOCOL NURSING DEPARTMENT CRITICAL CARE POLICY MANUAL CRITICAL CARE S EPTIFIBATIDE (INTEGRILIN) I. PURPOSE: A. Integrilin (Eptifibatide) is a specific and potent inhibitor of the platelet receptor glycoprotein

More information

The first 24 hours are critical when Activase (alteplase) is administered 1-3

The first 24 hours are critical when Activase (alteplase) is administered 1-3 FOR YOUR ACUTE ISCHEMIC STROKE PATIENTS The first 24 hours are critical when Activase (alteplase) is administered 1-3 Close observation and frequent monitoring of patients for neurological changes, any

More information

Bevacizumab + Paclitaxel & Carboplatin

Bevacizumab + Paclitaxel & Carboplatin Bevacizumab + Paclitaxel & Carboplatin Available for Routine Use in Not routinely commissioned, each case requires prior documented approval before offering & commencing therapy from NHS England Cancer

More information

Activase (alteplase) for injection, for intravenous use Initial U.S. Approval: RECENT MAJOR CHANGES

Activase (alteplase) for injection, for intravenous use Initial U.S. Approval: RECENT MAJOR CHANGES Guidelines for Achieving Door-to-Needle in 60 Minutes or Less Indication Activase (alteplase) is indicated for the treatment of acute ischemic stroke (AIS). Exclude intracranial hemorrhage as the primary

More information

Recombinant Factor VIIa for Intracerebral Hemorrhage

Recombinant Factor VIIa for Intracerebral Hemorrhage Recombinant Factor VIIa for Intracerebral Hemorrhage January 24, 2006 Justin Lee Pharmacy Resident University Health Network Outline 1. Introduction to patient case 2. Overview of intracerebral hemorrhage

More information

Supplement Table 1. Definitions for Causes of Death

Supplement Table 1. Definitions for Causes of Death Supplement Table 1. Definitions for Causes of Death 3. Cause of Death: To record the primary cause of death. Record only one answer. Classify cause of death as one of the following: 3.1 Cardiac: Death

More information

Disclosure. + Outline. What is a stroke? Role of imaging in stroke Ischemic stroke Venous infarct Current topics

Disclosure. + Outline. What is a stroke? Role of imaging in stroke Ischemic stroke Venous infarct Current topics + Kathleen R. Fink, MD University of Washington 5 th Nordic Emergency Radiology Course May 21, 2015 + Disclosure My spouse receives research salary support from: Bracco BayerHealthcare Guerbet Thank you

More information

DRUG GUIDELINE. HYDRALAZINE (Intravenous severe hypertension in pregnancy)

DRUG GUIDELINE. HYDRALAZINE (Intravenous severe hypertension in pregnancy) DRUG GUIDELINE HYDRALAZINE (Intravenous severe hypertension SCOPE (Area): FOR USE IN: Labour Ward, HDU, Theatre and ED EXCLUSIONS: Paediatrics (seek Paediatrician advice) and other general wards. SCOPE

More information