7-Ds of management of stroke patients:
Detection
Dispatch
Delivery
Door
Data
Decision
Drug
Stroke: Checklist for thrombolytic therapy
Check the indications that apply:
- Patient is 18 years of age or older
- Time of symptom onset can be identified accurately
- Thrombolytic therapy can be started within 3 hours of symptom onset
If all the 3 in step I are checked, then review the absolute contraindications below and check the ones that apply:
- Head CT scan today shows intracranial bleeding
- Head CT scan today shows no intracranial bleeding but the clinical presentation is suspicious for subarachnoid hemorrhage
- Head CT scan today shows multilobar infarction (hypodense area > one-third the area of the cerebral hemisphere)
- Any of the following within the past 3 months: intracranial or intraspinal surgery, serious head trauma, or a witnessed seizure
- Witnessed seizure since the onset of symptoms
- BP >185 mm Hg (systolic) or >110 mm Hg (diastolic)
- Arterial puncture at non-compressible site within the past 7 days
- Risk of hemorrhage:
a) Evidence of active internal bleeding
b) Patient has an arteriovenous malformation, aneurysm, or neoplasm
c) Prior history of intracranial hemorrhage
d) Lab evidence of a coagulopathy (e.g., platelet count <100,000/microliter
e) Patient on coumadin and INR at or above 1.7 or patient received heparin in past 48 hr and aPTT above normal range
If none of the boxes in step 2 are checked, review the relative contraindications below and check any that are considered an unacceptable risk:
- Major surgery or serious trauma in past 14 days
- GI or urinary tract bleeding within the past 21 days
- Acute MI in past 3 months or post-MI pericarditis
- Blood glucose <50 mg/dL or >400 mg/dL
If all boxes in step 1 are checked, and no boxes in steps 2 and 3 are checked, then give thrombolytic therapy.