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CCF Orders

Cleveland Clinic Foundation Coordinated Care Tracks: Admission Orders

Thrombolysis Admission Orders

Vitals:

  • Vital signs and neurochecks q 15 min x 2 hours then q 30 min x 6 hrs, then q 60 min x 18 hrs
  • If BP > 185/110, repeat in 5-10 min, if still elevated call HO
  • Arterial line
  • If on 2 consecutive readings 5-10 min apart SBP 180-230 or diastolic BP is 105-120:
    consider: Labetalol 10 mg IV over 1-2 minuter. dose may be repeated or doubled every 10-15 min up to 150 mg monitor BP q 10 min during therapy-observe for hypotension
  • If BP on 2 consecutive reading 5-10 min apart systolic BP greater than 2 or diastolic BP 121-140:
    consider: give labetalol 10 mg IV over 1-2 min dose may be repeated and/or doubled every 10-15 min up to 150 mg if satisfactory response not obtained, use nitroprusside monitor BP q 10 min during therapy- observe for hypotension

If diastolic BP is greater than 140:

  • IV sodium nitroprusside (100mcg/250ml 0.9%NS) (0.5-1.0mcg/kg/min) monitor BP q 10 min observe for

Hypotension

  • No antiplatelet or anticoagulant therapy for 24 hours post thrombolysis
  • Avoid blood draws or invasive line/procedures for 24 hours post thrombolysis
  • Call house officer if change in neurologic status

If suspected intracerebral hemorrhage: Stop thrombolytic immediately.

  • Stat non contrast heat CT

For life threatening hemorrhage:

  • 6-8 units platelets
  • 6-8 units cryoprecipitated fibrinogen and plasma containing factor VIII
  • Labs: CBC, PT, PTT, fibrinogen, type and cross
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