administering thrombolysis early management
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Administering Thrombolysis Early Management. Angela Roots Stroke Practice Facilitator [email protected]. What have we learnt so far?. What we have learnt so far. Why thrombolyse Inclusion/exclusion Family Medical history/pre-morbid state LAS decision making Assessment (NIHSS) - PowerPoint PPT PresentationTRANSCRIPT
Administering ThrombolysisEarly Management
Angela RootsStroke Practice [email protected]
What have we learnt so far?
What we have learnt so far...Why thrombolyseInclusion/exclusion
◦Family ◦Medical history/pre-morbid state◦LAS
decision makingAssessment (NIHSS)ScansTime
On arrivalLAS phone aheadBleep system activatedStroke team waiting in ED History from LAS & familyAdmit patient, portable
monitoring, CT Scan
What next?ConsentIV accessObservationsPre-empting riskDoseAdministrationCommunication
ConsentUp to 4.5 hoursPost 4.5 hoursPt aphasic / confused / mental
health problemsFamily disagreesWhat would you do??
IV access2 cannulasMinimise and monitor puncture
sitesAsk for assistance after 3 failed
attempts
ObservationshypertensiveIf DBP>110mmHg or SBP >180
mmHg:IV labetalol 10 -20 mg over 1 minute,
repeated after 10 minutes till response Max. total dose 300 mg/24 hours
(HR>60bpm)
IV GTN (0.5-10mg/hour) and use same target parameters
What is your local policy?
ObservationshypertensiveHigher risk of bleedAvoid rapid drop in blood
pressureMonitor heart rateHeadache
Observations
Blood Sugar levels◦?cause of neurological deficit
INR◦Main laboratory◦CoaguCheck
Plan ahead, what are the risks?Bleeding
◦Puncture sites◦Wounds◦GI◦Cathlabs
DeteriorationAnaphylaxisOvernight coverStaffing skill mixCeiling of care
Dose0.9mg/kg
Weight requiredEstimated vs actual
90mg maximum dose
Estimate the weight
52kg
89.6kg
Dose and administration10% total dose given as a bolus over 2 minutes then remainder via infusion pump over 1 hour
Dose and administrationKeep dose calculation
chart handyEnsure clear prescription
of total dose or bolus then infusion to avoid confusion once bolus administered
Avoid double concentration 1mg/1ml
Dose and administrationOften need more than 1 vial of
drug so 2 syringes to be completed
Monitor for extravasation carefully
Keep check on infusion pump rate during the hour
Ensure the infusion tubing is flushed slowly at completion to ensure the 2ml in the infusion tubing is administered
Dose and administrationBefore you give the drug;
◦Stop, stand back, reassess◦Signs of improvement?
LocationED Resus areaBolus in CT scanning department
(fully monitored)HASU ? What do you think?
CommunicationPatient, family, carersWard
◦Staffing capacity ◦Skill mix◦Cardiac monitored bed
Bed manager/ site nurse practitioner
So do you think
we should thrombolyse?
Yes! Lets go, time
is brain!!!