Abel – Case Study 5 of 6
Highlight
The nurse reviews the 1200 note, two hours after initial assessment.
Rationale
Highlight these findings:
🔴 Sudden 10/10 headache “worst of her life” — cardinal post-tPA warning sign of hemorrhagic transformation
🔴 Right arm weakness worsened, can’t move on command — neuro decline after initial improvement
🔴 LOC decreased, responds to pain only — critical deterioration consistent with expanding hemorrhage or herniation
🔴 BP 148/88 → 182/106 — hypertensive surge consistent with rising ICP
🔴 New 30-sec shaking episode — new seizure as complication of worsening intracranial event
Do NOT highlight:
CT confirmed ischemic stroke — correct diagnosis and treatment pathway
tPA within window — timely and appropriate intervention
BP 148/88 at 1100 — acceptable post-tPA parameter
Mild dysarthria improvement — expected positive initial response
Neuro checks q15 min — correct protocol adherence
Son at bedside — contextual finding only
Action: Stop tPA, emergent CT, notify provider + neurology, prepare for neurosurgical intervention.
Highlight these findings:
🔴 Sudden 10/10 headache “worst of her life” — cardinal post-tPA warning sign of hemorrhagic transformation
🔴 Right arm weakness worsened, can’t move on command — neuro decline after initial improvement
🔴 LOC decreased, responds to pain only — critical deterioration consistent with expanding hemorrhage or herniation
🔴 BP 148/88 → 182/106 — hypertensive surge consistent with rising ICP
🔴 New 30-sec shaking episode — new seizure as complication of worsening intracranial event
Do NOT highlight:
CT confirmed ischemic stroke — correct diagnosis and treatment pathway
tPA within window — timely and appropriate intervention
BP 148/88 at 1100 — acceptable post-tPA parameter
Mild dysarthria improvement — expected positive initial response
Neuro checks q15 min — correct protocol adherence
Son at bedside — contextual finding only
Action: Stop tPA, emergent CT, notify provider + neurology, prepare for neurosurgical intervention.
