Ischemic Stroke

Question 1

What is the time window for administering tPA in ischemic stroke management?

Answer 1

4.5 hours

The time window starts from when the patient was last confirmed to be normal.

Question 2

What must be known to correctly determine the start of the 4.5-hour window for tPA administration?

Answer 2

When the patient was last observed normal

If the patient was asleep prior to the stroke, the exact time they started sleeping must be known.

Question 3

Why might tPA not be given if a patient awoke from sleep and has stroke symptoms?

Answer 3

The stroke could have occurred while the patient was asleep

The last observation of no stroke signs was likely the night before.

Question 4

What is the first-line treatment for ischemic stroke if the 4.5-hour window has elapsed?

Answer 4

Aspirin

Aspirin is used when tPA cannot be administered due to time constraints.

Question 5

What is the target blood pressure for administering tPA?

Answer 5

Below 185/110

Blood pressure must be controlled to facilitate the safe administration of tPA.

Question 6

What should be done if blood pressure exceeds 185/110 before tPA administration?

Answer 6

Rapidly bring it down below 185/110

After achieving this threshold, cautious/slower BP control is recommended.

Question 7

What is the most important contraindication for tPA administration?

Answer 7

Blood pressure over 185/110

If either the systolic or diastolic value exceeds this threshold, tPA should not be given.

Question 8

List other important contraindications for tPA besides high blood pressure.

Answer 8

• Low platelets
• High PT or aPTT
• History of GI bleed past 21 days
• History of intracranial bleed
• Recent major surgery

These contraindications are critical to consider during ischemic stroke management.