Thanks to Dr Janice O'Connell for this case....we're back in the stroke ward
Mr John Brown is 71 years old and is brought to the ED by 999 ambulance. He arrives at the hospital at 10.30am. He became unwell while eating his breakfast. His wife noted that John had slumped to the right side, the right side of his mouth was drooping and he had difficulty speaking. This happened at 9.15am.
He has a past history of ischaemic heart disease and had a coronary artery stent inserted 18 months ago.
He is reviewed immediately by the stroke nurse, who notes that the patient has a right hemiparesis, expressive and receptive dysphasia and possible right visual field deficit.
His NIHSS score is 15. An urgent CT head scan is performed, which shows a dense clot in the left middle cerebral artery. He is assessed by the stroke consultant at 11.00am as a possible candidate for thrombolysis.
Please prescribe the appropriate bolus dose and infusion of alteplase for the patient, using the chart provided.
In order to get some prescribing resources out there we intend to publish a series of prescribing problems on the website. The problems will appear at least weekly with the "answers" appearing a couple of days later. We'll use the standard exam stationery available on the LSE, but also available below in case you haven't got access to the LSE.