It’s the afternoon and three level 1 trauma codes have come and gone. You are sitting in front of your computer schmoozing with your senior who is clearly not listening to you. She is obviously thinking about that job that she got on that other “better coast” with sunshine, organic starfruit and “proper Mexican food”.
Mid-sentence you suddenly notice that you are dysarthric, slouched to your left side, and you know what? You peed your pants, why not.
You strip, place a large bore IV in your neck and drag yourself to the scanner, cause that’s the person you are.
Assuming no intracranial bleed, are you a candidate for fibrinolysis, assuming you are 32, take no medications and have no life outside of residency? Depends on your FINGER STICK (I tricked you). Inclusion criteria are:
What Criteria would Exclude you from receiving tPA? A million of them, some of which are pretty obvious. Just look them up (after reading this). 1) Trauma, neurosurgery, or stroke within the last 3 months. 2) High clinical suspicion for subarachnoid hemorrhage. 3) Active internal bleeding 4) Current use of anticoagulation w/INR >1.7 5) Current use of direct thrombin or Xa inhibitors 6) Blood glucose <50 7) Arterial puncture in a non compressible site in past 7 days 8) Platelet count < 100,000 9) Intracranial neoplasm, AVM, or aneurysm. 4.5 hours: 10) Mutilobar infarct 11) NIHSS > 25 12) Age >80 13) History of previous stroke + Diabetes
References:
Written by Itamar Goldstein MD
Special Thanks to Dr. James Willis
Itamar
Latest posts by Itamar (see all)
- Possessed? No Bored - August 25, 2016
- Ironed-Bored-Review - April 27, 2016
- Was Bored so Took Too Much – Review - March 16, 2016
0 Comments