| Case | Date | Arrival | NIHSS | Door→CT | Door→Needle | Door→Puncture | Dx |
|---|
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TNK is preferred. Do not use the 0.4 mg/kg (cardiac) dose. Window: ≤4.5 h from last known well with a disabling deficit.
Tick anything present. One tick means no lytic.
Before lytic or EVT
During and 24 h after lytic
Target SBP
range 130–150
10–20 mg IV over 1–2 min (about 0.15–0.3 mg/kg, max 20 mg per dose). Repeat every 10 min. Infusion 2–8 mg/min. Max 300 mg in 24 h.
Avoid with asthma or COPD, HR <60, 2nd/3rd-degree block, decompensated HF.
Start 5 mg/h. Increase 2.5 mg/h every 5–15 min, max 15 mg/h. Drop to 3 mg/h at goal.
Start 1–2 mg/h. Double every 2–5 min, max 21 mg/h.
Avoid with soy or egg allergy.
10–20 mg IV every 4–6 h. Second line.
Only for refractory DBP >140 when nothing else works.
Verify all doses against institutional protocol.
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