administering thrombolysis early management
DESCRIPTION
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
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What have we learnt so far?
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What we have learnt so far...Why thrombolyseInclusion/exclusion
◦Family ◦Medical history/pre-morbid state◦LAS
decision makingAssessment (NIHSS)ScansTime
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On arrivalLAS phone aheadBleep system activatedStroke team waiting in ED History from LAS & familyAdmit patient, portable
monitoring, CT Scan
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What next?ConsentIV accessObservationsPre-empting riskDoseAdministrationCommunication
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ConsentUp to 4.5 hoursPost 4.5 hoursPt aphasic / confused / mental
health problemsFamily disagreesWhat would you do??
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IV access2 cannulasMinimise and monitor puncture
sitesAsk for assistance after 3 failed
attempts
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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?
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ObservationshypertensiveHigher risk of bleedAvoid rapid drop in blood
pressureMonitor heart rateHeadache
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Observations
Blood Sugar levels◦?cause of neurological deficit
INR◦Main laboratory◦CoaguCheck
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Plan ahead, what are the risks?Bleeding
◦Puncture sites◦Wounds◦GI◦Cathlabs
DeteriorationAnaphylaxisOvernight coverStaffing skill mixCeiling of care
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Dose0.9mg/kg
Weight requiredEstimated vs actual
90mg maximum dose
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Estimate the weight
52kg
89.6kg
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Dose and administration10% total dose given as a bolus over 2 minutes then remainder via infusion pump over 1 hour
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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
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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
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Dose and administrationBefore you give the drug;
◦Stop, stand back, reassess◦Signs of improvement?
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LocationED Resus areaBolus in CT scanning department
(fully monitored)HASU ? What do you think?
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CommunicationPatient, family, carersWard
◦Staffing capacity ◦Skill mix◦Cardiac monitored bed
Bed manager/ site nurse practitioner
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So do you think
we should thrombolyse?
Yes! Lets go, time
is brain!!!
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