Fibrinolytic Check list

ICH 3/100 develop intracranial bleed

Indications Inability to get a cath lab

Hypertension 200/110

R/O aortic Dissection Difference in BP of arms >15mmhg

CNS Bleed Hx /Stroke hx/trauma/GI bleed/pregnancy

Absolute contraindications

If any of these factors exist, you should NOT administer a fibrinolytic agent¹:

• History of any intracranial hemorrhage
• History of ischemic stroke within the preceding three months (unless it is an acute ischemic stroke occurring within the last three hours, then fibrinolysis is useful!)
• Presence of a cerebral vascular malformation or a primary or metastatic intracranial malignancy
• Symptoms or signs suggestive of an aortic dissection
• A bleeding diathesis or active bleeding, (menstruation is an exception)
• Significant closed-head or facial trauma within the preceding three months.

Relative contraindications

If any of these factors exist, you should consider NOT administering a fibrinolytic agent¹:

• Severe hypertension or uncontrolled hypertension (blood pressure >180 mm Hg systolic and/or >110 mm Hg diastolic
• Ischemic stroke longer than three months ago
• Dementia
• Any known intracranial disease that is not an absolute contraindication
• If cardiopulmonary resuscitation was administered for >10 min
• Major surgery within the last three weeks
• Internal bleeding within the last two to four weeks
• Vascular punctures that could not be compressed if they were to start bleeding
• Pregnancy
• Currently on warfarin therapy
• Any allergic reaction to fibrinolytic drugs in the past

Wide Complex Tachycardia V Fib at 4:04

Scenario 1

1 – Conciousness NOT OK

2 – Breathing NOT OK Oxygen and Possible Airway

3 – Pulse Neg

4- BP <90

5 – Monitor

DX ventricular Fibrillation Unstable

Ventricular fibrillation, or VF, is the classic arrest scenario. It is a rather easy rhythm to recognize on the monitor and responds well to CPR and defibrillation, but it is deadly if not treated immediately. Essentially, the ventricles are quivering in ventricular fibrillation, thus no blood is being circulated and perfusion is nil in this rhythm. Without immediate CPR, this lethal rhythm will eventually deteriorate into asystole and death. In some situations, it may be difficult to shock a patient out of VF, and this is when drugs are used.

RX DRUG/SHOCK  Non Synchronised/ DRUG/SHOCK  Non Synchronised

Epineprine  1mg (1/10,000)/ every 3-5min NO MAX

SHOCK  Non Synchronised

Amiodorone 300 mg over 10 minutes iv infusion followed by 150mg  to max dose of 2.2g /24 hrs

Lidocaine 1-1.5mg/kg IV push Repeat .5mg-.75mg/kg

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