full dose TPA pushed on a cardiac arrest

[JiraiyaSama]

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I'm a pharmacist that responded to a code on the floor @ 0200.

Anyways, the ER doc asked for TPA for a cardiac arrest taking place on one of the telemetry beds. We pushed the bolus and were getting ready to hang the remaining infusion when the ER doc took the bag out of the nurses hand and squeezed the remaining into the patient.

The patient ended up in the ICU with an intracranial bleed and bleeding out of all of his IV sites. The pt expired the next day.

Is there any evidence supporting pushing everything in? We hardly ever use TPA. We have an emergency cath lab team on call also, should this patient have been sent their instead for an emergency cath?

Am I liable for anything since I did not oppose the push?

 

[Sparda29]

Link to a discussion about this on SDN:

http://forums.studentdoctor.net/showthread.php?t=560781

 

[WVUPharm2007]

Do you people do 10% total dose bolus, then the rest over an hour? Anyway...wait...so he gave the bolus...and then he manually squeezed a bag with an hour's worth of tPA nto the patient? I've never heard of someone doing that, but I'm 8 months removed from a hospital job in BFE when I helped run a code once every 4 weeks or so, so what do I know.

Yeah...I don't think you are liable, anyway.

 

[Sparda29]

Do you people do 10% total dose bolus, then the rest over an hour? Anyway...wait...so he gave the bolus...and then he manually squeezed a bag with an hour's worth of tPA nto the patient? I've never heard of someone doing that, but I'm 8 months removed from a hospital job in BFE when I helped run a code once every 4 weeks or so, so what do I know.

Yeah...I don't think you are liable, anyway.

Also, from what I've heard, tPA is a hail mary pass in cardiac arrest when all else has failed. Damned if you do, damned if you don't.