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Acute brain attack protocol

Topic: Adult

Created on Friday, July 7 2006 by jdmiles

Last modified on Wednesday, August 30 2006.

A 96 year-old male kumquat washer went to bed in his normal state of health at 8:00pm last night, and woke up this morning with left-sided weakness, a facial droop, dysarthria, left-sided numbness, and a left homonymous hemianopsia. Your neurologic exam reveals these same findings. The patient is breathing comfortably at 14 breaths per minute. Heart rate is 97, and blood pressure is 154/97. Fingerstick glucose, CBC, Chem7, Coags and Fibrinogen are within normal limits. CT of the head shows no acute changes. The patient's second cousin, who accompanied the patient, provided the history given. The time is now 6:00am. The patient weighs 119 kg. Of the following options, which is closest to the dose of tPA this patient should receive?

A) 71.4 mg tPA given intraarterially

B) 10.71 mg tPA IV

C) None

D) 0.714 mg tPA given intraarterially

E) 107.1 mg tPA IV

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This question was created on July 07, 2006 by jdmiles.
This question was last modified on August 30, 2006.

ANSWERS AND EXPLANATIONS

A) 71.4 mg tPA given intraarterially

This answer is incorrect.

10 hours have passed since the patient was last seen normal. IV tPA is contraindicated after 3 hours, and intraarterial tPA is contraindicated after 6. tPA should not be given to this patient.¹ (See References)


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B) 10.71 mg tPA IV

This answer is incorrect.


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C) None

This answer is correct.


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D) 0.714 mg tPA given intraarterially

This answer is incorrect.


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E) 107.1 mg tPA IV

This answer is incorrect.


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References:

1. Adams, H.P., Adams, R.J., Brott, T., del Zoppo, G.J., Furlan, A., Goldstein, L.B., Grubb, R.L., Higashida, R., Kidwell, C., Kwiatkowski, T.G., Marler, J.R., Hademenos, G.J. (2003). Guidelines for the early management of patients with ischemic stroke: A scientific statement from the Stroke Council of the American Stroke Association. Stroke, 34. Pp. 1056-1083.


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adult
Acute brain attack protocol
Question ID: 708200601
Question written by J. Douglas Miles, (C) 2006-2009, all rights reserved.
Created: 07/07/2006
Modified: 08/30/2006
Estimated Permutations: 178200