Q: At my hospital, our STEMI patients are taken directly to the catheterization laboratory, but we also admit many patients who receive tenecteplase and are then transferred to us. What should the frequency of neurologic checks be for these patients?

A: Dea Mahanes, RN, MSN, CCRN, CNRN, CCNS, replies:

Primary percutaneous coronary intervention (PCI) is the preferred treatment following acute ST-segment elevation myocardial infarction (STEMI) if it can be provided within 120 minutes of the first medical contact. If PCI cannot be provided within the recommended time frame, administration of a fibrinolytic agent is suggested with a goal of administration within 30 minutes of arrival. As you note, patients who go to hospitals that do not offer PCI and receive fibrinolytic therapy are subsequently transferred to PCI-capable facilities for further evaluation and intervention.1 Patients treated with fibrinolytic therapy are at risk for bleeding complications, including intracranial hemorrhage (ICH). Ischemic...

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