NEUROQBANK

Announcements: Neuromuscular section updated with more questions.

Administration of blood products will be at the discretion of the stroke attending

 

After administration of IV t-PA, monitor for following concerning symptoms:

-           Worsening or new deficits, worsening GCS or NIHSS or decreased level of consciousness

-           Nausea, vomiting, sudden severe headache

-           Seizure

-           Sudden elevated blood pressure and/or bradycardia

If intracranial hemorrhage is presumed

-           Immediately discontinue t-PA infusion

-           Obtain STAT head CT scan

-           Re-assess the patient’s neurologic status – perform and document NIHSS

-           Draw labs: type and screen to blood bank ONLY if patient is new to YNHH

 

Immediately, upon documentation of intracranial hemorrhage by CT scan (preliminary read is acceptable):

-           Call blood bank (688-2443)

-           Order 10 units (volume approximately 50 mL) of cryoprecipitate

-           If patient received an antiplatelet agent during the prior 2 weeks, or if an antiplatelet use during that interval is unknown, also order 8-10 units platelets (volume approximately 400-500 ml)

-           Consider pre-medication 30 mins prior to transfusion (acetaminophen 650 mg PO or PR and/or diphenhydramine 25 mg IV)

 -           Cryoprecipitate will be administered IV (using a 22 gauge) over 15 mins

-           Platelets will be administered IV (using a 22 gauge) over 30-60 mins

-           If the patient exhibits signs of transfusion reaction, immediately stop platelet infusion

 -           STAT Neurosurgery consult (370-4492)

-           Consider Hematology consult (688-2443)

-           Discuss medical versus surgical therapy

 -           Repeat lab draw (PT, PTT, INR, fibrinogen) after administration of cryoprecipitate

-           If PT/PTT is elevated, consult heme for further recommendations

-           If fibrinogen < 150 mg/dl, order and administer additional 10 units cryoprecipitate

-           Consider serial CT scans to assess size and change of hemorrhage

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