TPA - How aggressive?

[HikingEDRN, BSN, RN]

For those of you who work with stroke patients, how aggressive are your docs with ordering tPA? I had a situation a few weeks ago (without giving too many details) where I was very uncomfortable with giving it. The ED doc didn't want it either but the neurologist did. NIH was very low. Luckily, the patient started improving and ultimately went back to baseline. Also, we started to have some changes to the story about how long the symptoms had been going on. It didn't come to it (and I'm not trying to be melodramatic) but I was getting to the point where I was going to refuse to push it and hang it.

Don't get me wrong, I know how awesome tPA can be - I have watched a flaccid woman (in her 50's) with a forced deviated gaze who could not speak regain virtually all functions by the time I wheeled her to the ICU. Discharged from the hospital with only slight hesitancy in speech. I just think we need to be reasonably sure that the patient needs it. I know it's time-sensitive but I often feel like neurology wants to rush to give it immediately.

Just curious about others' experience. I work at a stroke certified facility but it is not a teaching hospital so I only deal with attending physicians.

[Christy1019, ASN, RN]

I have seen both sides of the coin. Some docs TOO aggressive, others too unsure/hesitant to give it. A few weeks ago a new physician was insistent on giving it to someone and the nurses were all against it (or so I'm told, I wasn't there) but gave it anyway, only to find out it was a drug overdose, not CVA afterall. Ugh...

[HikingEDRN, BSN, RN]

Thanks for your reply. I've never been in a position of wanting to give it but not having the docs order it, like I said, neuro is pretty aggressive. I think we had a situation where it was given and it turned out to be a psych situation but I just heard about it later.