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).
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