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|Date of referral | |

|Time of referral | |

|Nurse accepting referral | |

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Appendix 1

Thrombolysis absolute contraindications. Do NOT administer if answering Yes to any of the following

Thrombolysis relative contraindications. Do NOT administer if answering Yes to any of the following until discussed with the most senior doctor available.

Appendix 2

Administration of thrombolytic therapy.

Tenecteplase (TNK) dosing regime.

|Body weight (kg) |Tenecteplase (u) |Tenecteplase (mg) |Volume (ml) |

|30 mins < 12 hours)

• Pain not relieved by nitrates

plus

ECG changes

1mm or > ST elevation in 2 limb leads in

Gradual onset of pain (>30 mins < 12 hours)

Pain not relieved by nitrates

plus

ECG changes

1mm or > ST elevation in 2 limb leads □

2 mm or > ST elevation in 2 or more adjacent chest leads □

New left bundle branch block □

NO

Suspected aortic aneurysm / dissection □

Previous cerebral haemorrhage or stroke of unknown origin at any time □

Ischaemic stroke in preceding 6 months □

Known bleeding disorder □

Central nervous system trauma or neoplasms □

Gastrointestinal bleed in last 4 weeks □

Unresponsive □

Referral Mon-Thurs 8.45am – 5pm or Fri 8.45am – 12 noon

NO

Direct admission to CCU for assessment and management.

Discuss with consultant on call

Ask SAS crew

“Can you be at Raigmore Hospital within 90 minutes drive time and before 5pm Mon-Thurs (before noon Fri)?”

TIA in preceding 6 months □

Trauma / relevant surgery (including resuscitation) within last 3 months □

SBP>180 and / or DBP>110 despite analgesia, IV nitrate and IV beta blocker □

Pregnancy or less than 4 weeks post partum □

Pain free or > 12 hours since pain onset □

Advanced liver disease □

Active peptic ulcer □

Infective endocarditis □

Other relevant condition (specify) □

YES

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Thrombolysis / Primary PCI Pathway

Transfer to CCU.

(PCI within 24 hrs)

Rescue PCI within Cath Lab hours if failure to reperfuse.

or

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