ACS Stroke Sepsis

Cincinnati Stroke Program

tPA-Induced ICH

Management of Suspected ICH Following tPA

1. Stop tPA Immediately
2. Stat Noncontrast Head CT
3. Vitals every 15 minutes
4. Oxygen 2L NC, Maintain Sats >95%
5. Labs: CBC, PT/PTT, Fibrinogen, T&C, 4 Units pRBCs, 4 Units FFP/Cryo
6. Contact: Neurosurg, Family, PMD
7. Strict BP Control (Nipride/Labetolol

If ICH Has Occurred:

1. Obtain bleeding time
2. Consult Hematologist
3. If ele
4. PT/INR-give FFP, if fibrinogen low-give cryoprecipitate 250(mg/unit)

References

Cincinnati Stroke Team, 2007. This pathway has not been prospectively validated.

Select ABCD2 Score Anticoagulation BP Management (Ischemia) BP Management (Hemorrhage) Brain Death Exam Cincy Prehospital Stroke Cranial Nerves DVT Management Elevated INR Management Fischer Scale (SAH) Glasgow Coma Score Glasgow Outcomes Scale Heparin-Induced ICH Hounsfield Units Hypercoagulation Labs Hunt Hess (SAH) ICH Rates ICH Score ICH Volume ICP Management Imaging In Stroke Ischemic Outcomes Key History Elements Labs/Studies to Order LA Prehospital Stroke Mean Arterial Pressure Modified Rankin Score NIH Stroke Scale Physiologic Management Phenytoin Correction Resources Stroke Mimics Stroke Syndromes Temperature Conversion tPA Dosing Calculator tPA-Induced ICH tPA Criteria Weight Conversion WFNS (SAH)

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