Consent for tPA

[Arcan57]

Assuming you give tPA for stroke, do you try and track down relatives to give consent if the patient is unable? Is it ethical to wait while explaining to one (or more) sets of relatives the risks/benefits to cover yourself knowing that the earlier tPA is given the better?

---

Members don't see this ad.

 

[mikecwru]

Assuming you give tPA for stroke, do you try and track down relatives to give consent if the patient is unable? Is it ethical to wait while explaining to one (or more) sets of relatives the risks/benefits to cover yourself knowing that the earlier tPA is given the better?

The way I would reason this out is that it would depend on what you reasonably think the benefits of tpa are. If you are towards the "pro," side, then I would argue that you would give it and not delay. You wouldn't delay a chest tube for a tension pneumo, even though there's risk.

mike

 

[emergiQ]

The way I would reason this out is that it would depend on what you reasonably think the benefits of tpa are. If you are towards the "pro," side, then I would argue that you would give it and not delay. You wouldn't delay a chest tube for a tension pneumo, even though there's risk.

mike

This one is clouded by the fact that the NINDS data for tPA is really not that great. When I feel that I've been left in a quandary -- and in this case, it is relatively weak data compared to the general public's assumption of efficacy of the 'clot buster' drug -- I absolutely DO NOT give this drug without consent. I won't invoke emergency consent if I don't have a clear understanding that the patient would be willing to risk catastrophic bleed for a chance at meaningful recovery. I also feel that if the time constraint is closing in, I'd rather take the extra time to get consent and go for IA tPA (6 hour window) rather than rush it with the 3 hour window for systemic.

Having said that, if it was me? I'll paraphrase one of my classmates: Give me double the dose -- I either want to get better, or go to the sweet thereafter then and there.