AIS after tPA

Template for plan of management (Ischemic Stroke after tPA)

Plan: 

Stroke acute management:
- Admit to stroke unit
- Frequent neuro-checks (q15min for 4h then q1h for 24h then q4h)
- Permissive HTN up to SBP 180
- Baseline EKG and CXR
- Basic labs: CBC,CMP, coagulation panel and troponin
- Intravenous hydration with normal saline at 75cc per hour
- Patient passed the bedside swallow eval, started on dysphagia diet. ***
- Head of bed > 30 degrees for aspiration prevention and aspiration precautions ordered.

After tPA administration (Started at ------):
>Neurochecks: Every 15 mins x two  hours, then every 30 mins x6 hours, then every hour x 16 hours.
>No foley removal or placement for 24 hours
>No venous/arterial puncture at non-compressible site
>No anticoagulation or anti-platelet agents for 24 hours
>Cardene drip as needed to keep BP < 180/105

Stroke workup:
-CTH:
-CTA:
-MRI:
-Trans-thoracic echocardiogram
-Continuous cardiac telemetry to monitor for arrhythmia
-Stroke labwork: HgbA1C, lipid panel, urine drug screen

Secondary prevention of stroke:
-Aspirin 325mg daily will be started 24h after tPA
-Atorvastatin 40 mg daily (long-term goal LDL < 70)
-Tight glucose control (long-term goal HgbA1c < 6%)
-Stroke education and counseling
-Rehabilitation: physical therapy, occupational therapy, speech therapy consults
-Consulted social work and case management for help with discharge

Other medical issues:
DM:

HTM:

​Prophylaxis: SCDs (DVT), will start heparin 24h after tPA, famotidine, docusate (GI)

Patient was discussed with the stroke attending, will be formally staffed in morning rounds.

One thought on “AIS after tPA

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