anyone using tPA for acute ischemic stroke in the ED?

[dewp_63]

We've been discussing the use of tPA in the ED for acute non-hemorrhagic stroke patients. I know that ACLS teaches this algorithm, but our MD's are hesitant to institute. Some of their hesitancy in the fact that the local neuro docs don't like it. I know this is happening in some of the "stroke centers" in the nation, but I haven't found a nurse in our area who has participated in this... I practice in a large urban area, with a medical center/med school/nursing school etc. in the same city. Just needed to know if this is just something the very elite do, or if it is something I should expect to see soon.

[stbernardclub]

Anywhere I have seen TPA used, it gave the pt a 50/50 shot at improving hemiparesis. As stated above, a neurologist decides if the patient is a candidate. Having said that, even they are hesitant to use it becuase of the tight window required.Most of these patients who have strokes seem to live alone, or in a nursing home where noone can say for sure when the patient actually started to show signs of a stroke..There are risks to this medication, and for that reason, as you can imagine it is used rarely.

[talaxandra]

My experiences echo those already posted - we've used it from time to time, and were involved in the initial double-blind trial.

We're a trauma centre, and have no problm getting rapid assessment. The biggest issue, as already noted, is pinpointing time of onset - that narrow window's a real problem.

It's also frustrating that there's so little education about stroke - we just shipped a twenty-four year old with a dense hemi to rehab. He'd had symptoms, including significant left arm weakness and slurred speech, for three days before friends convinced him to present. Plus the number of pateints who've prresented to their GPs and not been sent straight in... argh!

On the results front I've seen patients with tremendous improvement, no real change, and a couple of really nasty bleeds.

[jlrn]

i have used tpa twice and noticed much improvement within a couple hours.

[veetach]

I have only used it once in 11 yrs. It made no difference with the progress of the pt, she was only 55 yrs old too. Sad situation.

[dewp_63]

Thanks for all your wonderful information. :) The prevailing thought seems to be that it is the neuro docs who are initiating (and thereby taking on the legal liability). Like I said, we can't get neuro here to do burr holes on young ICH patients, so I'm sure that we won't get a lot of response for CVA's. I'm not against the idea, I'm just hesitant without full back up (our ICU's are "medical" and "Surgical" - medical takes care of the usual ventilated long-term patients, and SICU is used primarily for our CABG patients. Because we have a interventional cath lab, we rarely give tPA to our MI patients, either!

[geekgolightly, BSN, RN]

at st. luke's in kc, we use arterial tPA up to 8 hours after and venous systemic 3-6 hours. we also use it in conjunction with the MERCI corkscrew device and our rates of recovery are almost tenfold national average.

[geekgolightly, BSN, RN]

at st. luke's in kc, we use arterial tPA up to 8 hours after and venous systemic 3-6 hours. we also use it in conjunction with the MERCI corkscrew device and our rates of recovery are almost tenfold national average.

[geekgolightly, BSN, RN]

here is a pretty cool protocol list from mass general

http://neuro-oas.mgh.harvard.edu/stopstroke/neurologist_protocols.htm

[geekgolightly, BSN, RN]

here is a pretty cool protocol list from mass general

http://neuro-oas.mgh.harvard.edu/stopstroke/neurologist_protocols.htm

[LLLLeah]

question for those using tPA for ischemic BA: has MRI been used for diagnostics, or strictly CT and symptoms?

[Tweety, BSN, RN]

Not having a neuro doc to manage a tpa is not a good idea imo.

But the nurses need to be able to do NIH stroke scales. Here we do them on all CVA patients, even those without tpa. I learned it on the job, but then went to an inservice. It's an excellent tool. I think we did it q8h for 24 hours, or something like that. I haven't worked the neuro unit in a few years, so I'm bit sketchy on the protocol.

Good luck.

[Tweety, BSN, RN]

question for those using tPA for ischemic BA: has MRI been used for diagnostics, or strictly CT and symptoms?

Strictly CVA and symptoms. The stroke won't show up on the CT if it's new, but a bleed will. The CT is used primarily to rule out a bleed. But if an acute CVA shows up on the CT scan, then it's too late for tpa.

MRIs are usually done later after they are admitted. :)