SCRN Chapter 5 Hyper acute stroke care Prehospital and Emergency Department Exam with Q and A

SCRN Chapter 5 Hyper acute stroke care Prehospital and Emergency Department Exam with Q and A 38. Your 58-year-old patient arrived within 3.5 hours of symptom onset and her CT scan shows acute intracerebral hemorrhage (ICH). Her husband has been at the bedside looking at his phone, and after the provider has spoken with him about his wife's scan, he asks when she is getting the drug alteplase. What is your best response? A. "Where did you hear about that?" B. "Your wife did not arrive within the timeframe for administering that drug." C. "Your wife's CT showed that she has bled in her brain, and alteplase is not safe for her case." D. "Alteplase has been studied for use in some hemorrhagic popula- tions, but your wife's provider doesn't like to do that." ANSWER 38. C A simple explanation of the fact that alteplase is not appropriate for a bleed-reinforcing what the provider had just told the husband-is enough. 39. A57-year-old woman presents to the emergency department (ED) 45 minutes after the onset of severe expressive aphasia, right hemiparesis, and hemisensory loss. Her National Institutes of Health Stroke Scale (NIHSS) score is 16. Past medical history is significant for coronary angioplasty and stent placement 4 years ago, and surgery on her left foot 5 days ago. She takes aspirin and clopidogrel. On initial presentation, the patient's blood pressure was 190/100 mmHg and is now 170/90 mmHg. Emergent labs and head CT are normal. The patient's symptoms improve to an NIHSS score of 3—aphasia (1), hemiparesis (1), and hemisensory loss (1). Which of the following is a contraindication to this patient receiving tisplasminogen activator (TPA)?