ECCT Southern Region



Acute Stroke Thrombolysis (Southland)

TIME IS BRAIN

• All patients must have had a Stroke Diagnosis Form (79592) completed before proceeding

• This document is only to be used where there is the initial intention to thrombolyse. If there is no intent to thrombolyse then please use Acute Stroke Pathway (Southland) (79593) documentation

It is vital that the details in this document be considered carefully, but one must act quickly as benefits of thrombolysis are likely to be greatest the earlier the treatment is given.

Blood glucose: _____ Rule out hypoglycaemia masquerading as stroke.

Blood pressure: _____ Note: Systolic ≥ 185 or diastolic ≥ 110 on repeated measures will need addressing.

(Give labetolol 10 mg IV bolus, then start an infusion at 2mg/ minute. Place labetolol 100mg (20mL) in 80 mL 0.9% sodium chloride solution to get a 1:1 solution (100mg labetolol in 100mL solution))

Temperature: ________(no evidence of sepsis, sub-acute bacterial endocarditis)

Stroke Thrombolysis Inclusion Criteria:

1. Rapid onset FOCAL neurological deficit – likely due to stroke Yes No

2. Symptoms for more than 30 minutes and NOT improving[1] Yes No

3. Clear onset of stroke symptoms less than 3½ hours ago Yes No

4. Age 18-80[2], previously independent Yes No

5. Critical Care Unit (CCU) bed is available Yes No

If yes to all above:

Time that the 4½ hour window will close is

Proceed to the exclusion criteria over the page.

Note that these criteria require completion of a Modified Rankin Scale and a National Institutes of Health Stroke Scale, both of which are provided in this document.

If no to any of the above:

Patient is not for thrombolysis – proceed to page 11 in this document - Acute Stroke Pathway Documentation.

Stroke Thrombolysis Exclusion Criteria:

Tick ‘Yes’ or ‘No’ for each and every item

|Yes |No | |

| | |Coma or severe obtundation with fixed eye deviation and complete hemiplegia. The NIHSS should be ≤ 22. |

| | |Minor stroke symptoms that are rapidly improving. This should be discussed with the on-call consultant. |

| | |Lack of disabling stroke symptoms. The NIHSS should usually be greater than four (see page 9). Occasional patients |

| | |with a lower NIHSS may still be considered for example patients with severe dysphasia. |

| | |History of stroke in previous 12 weeks. |

| | |Any pre-existing neurological illness resulting in a modified Rankin Scale, (see page 8), of three or higher. |

| | |Seizure prior to administration of tPA (alteplase). |

| | |Previously known intracranial or subarachnoid hemorrhages, arteriovenous malformation, aneurysm, or previously known |

| | |intracranial neoplasm that is terminal or would increase the risk of intracranial bleeding after tPA (alteplase), or |

| | |may confound neurological assessment. |

| | |Clinical presentation suggestive of subarachnoid hemorrhage, even if the initial CT is normal. |

| | |Hypertension: systolic blood pressure ≥ 185mmHg; or diastolic blood pressure > 110mmHg on repeated measures prior to |

| | |administration of tPA (alteplase). |

| | |NB - tPA (alteplase) may be given if the BP is able to be cautiously lowered to these levels within 4.5 hours. |

| | |Presumed septic embolus. |

| | |Myocardial infarction within past 30 days. |

| | |Biopsy of a parenchymal organ or surgery that would increase the risk of unmanageable (e.g. uncontrolled by local |

| | |pressure) bleeding after the administration of tPA (alteplase) in the past 30 days. |

| | |Recent trauma, with internal injuries/ulcerative wounds in the past 30 days. |

| | |Any hemorrhage in the last 30 days that would increase the risk of unmanageable (e.g. uncontrolled by local pressure)|

| | |bleeding after the administration of thrombolytic therapy. |

| | |Known hereditary or acquired hemorrhagic diathesis, e.g. APTT or PT greater than normal. Taking oral anticoagulant |

| | |(e.g. dabigatran, rivaroxaban, or warfarin therapy with an INR of > 1.3. |

| | |Pregnancy, lactation, or parturition within the previous 30 days. |

| | |Baseline glucose of < 2.8 or > 22.0 mmol/L, platelets ................
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