History of Present Illness:
A woman in her late 50’s with a history of ESRD and CAD on Plavix and 81mg aspirin presents to the ED with 1 hour of global HA, vomiting and weakness in the left leg and arm
Vital Signs & Physical Exam:
Vitals normal except BP of 188/122. Strength on left side arm and leg was 4/5. Right sided strength was normal. No facial weakness
Initial Diagnostic Testing:
What is the treatment for this?
- A) TPA
- B) Platelets and keep SBP <140
- C) Dialysis and keep SBP <160
- D) DDAVP and surgery
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What is the treatment for this?
- A) TPA
- B) Platelets and keep SBP <140 – CORRECT – This was recommendation from neurosurgery. (platelets because on Plavix/aspirin)
- C) Dialysis and keep SBP <160 – Nephrology recommended against emergent dialysis due to bleed
- D) DDAVP and surgery
1-Minute EM Consult on the topic for this case – click here
CASE CONCLUSION: Neurosurgery was contacted and recommended keeping SBP <140 and giving platelets to reverse Plavix. Admitted to ICU. Bleed did not progress.