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Old 06-14-2012
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Heart can this patient get tPA ?

A 69-year-old man with a prolonged history of hypertension and
diabetes mellitus is brought to the emergency department by his
daughter with right lower extremity weakness and slurred
speech. These symptoms developed suddenly over the last two
hours. One month ago, he underwent laparoscopic
cholecystectomy. He had a severe hematuria six weeks ago.
Upon arrival, his blood pressure is 160/90 mm Hg, and his heart
rate is 72/min. Neurological examination reveals right lower
extremity weakness with 3/5 motor strength and decreased
sensation in the same leg. Neck examination reveals a mild
carotid bruit on the left. The EKG shows normal sinus rhythm. A
CT scan of the head is normal. All laboratory tests are normal.
Which of the following is most appropriate at this time?
(A) Aspirin 325 mg daily
(B) Aspirin 325 daily and dipyridamole 200 mg twice a day
(C) Coumadin
(D) tPA intravenously
(E) Heparin intravenously
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Old 06-14-2012
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D...........?????/
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Old 06-14-2012
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id say give tPA-- so D
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Old 06-14-2012
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please give expln.
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Old 06-14-2012
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Quote:
Originally Posted by tyagee View Post
please give expln.
less than 2 hours of stroke symptoms...

C/I for thrombolytics --- bleed/venopuncture/arterial punture etc in last 7 days.

aspirin-- yes shud be started.. but since less than 3 hours-- give tPA first.
aspirin + Dipyradamole -- started only if the patient is already on aspirin and has a repeat stroke
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Quote:
Originally Posted by tyagee View Post
please give expln.
Indications/criteria for using tPA--

Inclusion criteria

□ Ischemic stroke with clearly defined time onset <3 hours

Exclusion criteria

□ History of intracranial bleed
□ Active Internal Bleeding
□ History of stroke or serious head trauma in preceding 3 months
□ GI or urinary tract hemorrhage within previous 21 days
□ Major surgery within 14 days
□ Arterial puncture in non-compressible site or lumbar puncture
within previous 7 days
□ Symptoms suggestive of subarachnoid hemorrhage
□ Seizure at time of stroke onset
□ Rapidly improving neurological deficient or minor symptoms
□ Hemorrhage in CT scan
□ Systolic pressure >185 or diastolic >110 on repeated
measurement or requiring aggressive treatment
□ Platelet count <100,000
□ Currently taking anticoagulants or receiving Heparin within 48
hours preceding the stroke (INR > 1.7; PTT elevated)
□ Blood glucose <50 or >400
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The above post was thanked by:
patelMD (06-14-2012), tyagee (06-15-2012), usmle 99 (06-15-2012), yarasara77 (07-14-2012)



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Cardiology-, Internal-Medicine-, Step-2-Questions

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