So being that I'm in a neuro-focused ER, we give lotsa the tPA. Here are a few points.
~ Our window is six hours from time of onset. However, I have never seen it given more than four hours out.
~tPA can only be given for an ischemic stroke. The patient will have a stat CT-Head (we strive for a door to CT time of 20 minutes)
~IF the CT is negative, but the patient is experiencing symptoms, we will screen the pt for eligibility, get permission, and give the juice. If you see an ischemic stroke on the scan, then it's too late to give tPA. Reason being that if you see the stroke, the stroke has been there too long to benefit from clot-busters.
~tPA has a six percent mortality rate due to head bleeds.
~Often, you'll see marked improvement in only a few minutes after giving it. Truly is a miracle drug. However, a large scale study just came out that shows tPA to be no more effective than an aspirin. More research really needs to be done, and other studies have shown it to be tremendously effective if used correctly.
~ You'll need to do more neuro checks in the next few hours than you've probably done in your life... unless you give tPA a lot. It is REALLY important to get a great baseline assessment of your patients neuro status. Without it, you won't have anything to go on.
~The very first sign that there may be a bleed is a subtle change in LOC. The patient will seem tired.... will stutter, or not recall certain things... may get agitated, combative, or just sit up in bed and have a wild look. Pupillary changes are a late sign of a bleed. While helpful to assess, it won't be the first thing you see. You may also see bleeding at IV sites, tachycardia (early) and bradycardia (late), blood pressure changes, etc. None of this is good. When you see it STOP THE TPA and do a stat head CT. tPA patients can herniate fast.
~When we give tPA I'll often sit in the room and just visit with the patient/family for about 30 minutes. I can do that because I don't have a patient assignment as charge, but a lot of nurses don't have that luxury. tPA pts should be 1:1, due to the high risk for bleed/death. I've caught a bleeds before, and it's scary. I've also seen a lot of fab outcomes from it as well.
Lemme know if you need anything else.