中風(stroke)的處理

1. 到院10'內，給予O2, IV, monitoring(SpO2, vital sign, 12leads EKG, ABG..)和一般神經學檢查。

2. 到院25'內，神經學檢查, taking history (onset 3 or 4.5 hors), >18yrs, with no contrast CT

3. 到院45'內判讀CT。

4. 到院60'內，給血栓溶解劑 r-tPA(tissue plasminogen activator) for >18yrs, or with ischemic stroke p't (有神經學損傷)
  
*劑量0.9 mg/kg, max 90 mg


*10% of total dose, iv bolus for 1'
*90% of total dose, iv drip for 60'

Absolute contraindications
1. ICH
2.SAH
3.Internal bleeding (21天內GI, GU bleeding)
4.Bleeding tendency (Plat <100,000)
5.Heparin used (within 48 hours) or Coumadin recently, PT>15''
6.Major surgery or trauma within 14 days
7.Lumbar puncture within 7 days
8.Hx of ICH or brain tumor
9.AVM
10.seizure at initial stage of stroke
11.recent MI
12.refractory BP(SBP>185, DBP>110 mmHg)

*中風不可給予D5W或過多輸液。
*Hyperventilation for maintaining PaCO2 30mmHg