Post-tPA hemorrhage in CVA

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 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.

6/06 MISTRY