Intern Report

Name: Christopher Chinnatambi

Date: 11/27/23

Post Thrombolytic Therapy Stroke management.

Disposition:

ICU placement

 General supportive measures:

 Airway support and supplemental oxygen if needed.
 Blood pressure Management
 Elevated body temperature, treat with antipyretics: Tyenol PO/Supp 650mg
 Maintaining blood glucose levels: 140-180 mg/dl
 Telemetery
 Fall precautions

Clinical Evaluation
 Neurochecks every hour which are done by the nurses and include NIH scoring.

Anti-Thrombotic/Anticoagulation:

 Hold antiplatelet therapy and anticoagulation(all anticoagulation for clot treatment and DVT
prophylaxis) therapy for 24 hours

Blood Pressure Management:

 Maintain BP < 180/105 mm Hg for at least 24 hours after t-PA

 Consider restarting antihypertensive medications after the first 24 hours after stroke onset in
patients who have preexisting hypertension and are neurologically stable unless known
contraindication exist

Neuroimaging:

 Repeat Head CT in 24 hours

Complications of Thrombolysis:

 Intracerebral hemorrhage
 Oozing from IV sites and angioedema
References:

1. Philip M. Bath,Lili Song,Gisele S. Silva,Eva Mistry,Nils Petersen,Georgios Tsivgoulis,Mikael

Mazighi,Oh Young Bang, Blood Pressure Management for Ischemic Stroke in the First 24,
doi.org/10.1161/STROKEAHA.121.036143Stroke. 2022;53:1074–1084

2. William J. Powers,Alejandro A. Rabinstein, et al. Guidelines for the Early Management of

Patients With Acute Ischemic Stroke: 2019 Update to the 2018 Guidelines for the Early
Management of Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the
American Heart Association/American Stroke Association,
doi.org/10.1161/STR.0000000000000211Stroke. 2019;50:e344–e418