EMERGENCY DEPARTMENT THROMBOLYTIC (t-PA) THERAPY FOR ACUTE STROKE STANDING ORDERS

DATE __________________ TIME ____________________

1. Obtain estimated/actual body weight in kg.

2. Establish IV access (18- to 20-gauge catheters)

Saline lock for blood draws

V 0.9% NaCL @ 60 ml/hr.

3. STAT CT scan of the brain without contrast (to be read prior to treatment).

4. Neuro consult with ___________________.

5. Lab work:

The following lab results must be obtained prior to treatment:

CBC

PT, PTT (if on anticoagulation)

The following must be drawn prior to treatment:

Renal panel/Chem 20

Type and screen, Fibrinogen

ESR

6. Total t-PA dose to be given: __________________ (0.9 mg/kg of body weight — max dose 90 mg)

10% bolus: _______________mg over 2-3 mins. followed by infusion remainder of dose over one hour.

7. Vital signs/neuro assessments every 15 minutes x 2 hours, every 30 minutes x 6 hours, then every 1 hour x 16 hours. (No automatic blood pressure machines.)

8. For minor bleeding, apply pressure over the site.

9. Diagnostics — to be completed after CT:

EKG

Chest X-ray

Urinalysis

10. Notify MD for ANY change in neurological status or major bleeding.

11. For Systolic B/P > ___________ or diastolic B/P > __________ give ____________________.

12. Transfer to ICU/neuro concentrated care when bed is available.

__________________________________

MD Signature

Source: Mercy Healthcare Sacramento (CA).