<p> Palms of Pasadena Hospital</p><p>Rev. 10/08</p><p>Page 1 of 1 Date/time tPa (Alteplase) ISCHEMIC STROKE ORDERS </p><p>1. Eligibility Criteria met & BRAT Flow Sheet signed. 2. Neurologist ______has cleared the patient.</p><p>3. ALLERGIES: 4. tPA(Alteplase) 0.9mg/kg I.V., 10% of dose administered as a bolus over 1 minute and the remaining 90% given Over next 60 minutes. Given as soon as criteria are met. Maximum Total dose <=90mg.</p><p>* Estimated weight _____ kg x 0.9mg/kg (weigh patient if possible) (2.2lbs=1kg) * Total Dose _____mg Bolus______Drip______</p><p>5. Admit to ICU 6. Vital Signs and LOC check every 15 minutes X 2 hours, then every 30 minutes x 6 hours, then every hour x 16 hours B. NIH Stroke Scale immediately before administration of tPa, then post infusion. Then use abbreviated NIHSS every 1 hour for 24 hours, then every 2hours X 24 hours. (full NIHSS for any neuro changes ) C. Notify physician for any changes in neurologic status. BP systolic > 180,diastolic >105</p><p>D. At least 2 IV's (18-20 gauge) in place (opposite arms) one for IV medication and one for Lab draws 7. Medications: For Systolic BP 180 – 230 or Diastolic BP 105 – 120 (for 2 readings, 15 minutes apart) ( ) Labetalol 10 mg IV over 1 – 2 minutes. Repeat Q 10 minutes to a total dose of 300mg/24hrs ( ) Labetalol 10mg IV over 1-2 minutes followed by an infusion 2-8mg/min, start @ 2mg/min then Increase by 1mg/min every 15 min prn to maintain BP for above parameters ( Infusion Mix100mg/100cc N/S.9% ) ( ) Enalapril 1.25mg ( )Enalapril 2.5mg IV every 6 hours prn to maintain BP for above parameters ( ) Cardene 5mg/hr (50mls/hr), Increase infusion rate by 2.5mg every 15 minutes prn to maintain BP for above parameters ( Infusion 25mg/240cc N/S .9%- 0.1mg/cc concentration) If Systolic > 230 or Diastolic > 120 call Physician Additional Medications: ( ) Tylenol 650mg PO or per rectal suppository every 4 hours prn headache 8. CT brain without contrast at 24 hours post tPA infusion</p><p>9. No Heparin for 24 hours after tPA.(Alteplase)</p><p>10. Implement Ischemic Stroke Order</p><p>Physician Signature______USE BALL POINT PEN - PRESS HARD ALL MEDICATION DISPENSED IN ACCORDANCE WITH HOSPITAL FORMULARY SYSTEM</p><p>ORDERS MUST BE SIGNED BY PHYSICIAN</p>