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Assessment - Thrombolytic Screening Form (CVA)

 


Clinical Indications:

= ______  1.       Suspected CVA patients

 

Procedure:

= ______  1.      Asse= ss and treat CVA patients as per protocol.

= ______  2.      Thro= mbolytic screening forms will be completed for all suspected CVA patients.

= ______  3.      Ther= e are seventeen screening criteria items on the form.

= ______  4.      Scre= en for the following criteria:

= a.&n= bsp;      Age > 18 years old

= b.&n= bsp;      Pt awake when symptoms started<= /p>

= c.&n= bsp;      Onset of symptoms < 3 hours<= /p>

= d.&n= bsp;      No rapidly improving or minor symptoms=

= e.&n= bsp;      No history of intracranial hemorrhage<= /span>

= f.&n= bsp;        No seizure at the onset of symptoms

= g.&n= bsp;      No stroke or serious head injury within 3 months<= o:p>

= h.&n= bsp;      No major surgery or serious trauma within 2 weeks=

= i.&n= bsp;        No GI or urinary tract hemorrhage within 3 weeks<= o:p>

= j.&n= bsp;        Systolic BP < 185 mmHg

= k.&n= bsp;      Diastolic BP < 110 mmHg

= l.&n= bsp;        No aggressive treatment to lower BP

= m.&n= bsp;    Blood glucose between 60 and 400 mg/dl=

= n.&n= bsp;      No symptoms of subarachnoid hemorrhage=

= o.&n= bsp;      No arterial puncture at non-compressible site or lumbar puncture within 1 week

= p.&n= bsp;      No pregnant or lactating female=

= ______  5.      If a= ll of thrombolytic form criteria are met (all NO’s), alert the receiving facility of possible

thro= mbolytic can= didate as early as possible.

= ______  6.      All sections of the form must be completed.

= ______  7.      The completed form will be attached to the signature sheet associated with the electronic PCR and a

copy= wil= l be left with the receiving facility.

 

Certification Requirements:

Succ= essfully complete a biannual evaluation including the indications, contraindications, technique, and possible complications of the procedure.

 

 

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