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(Solved by Expert Tutors) A 72-year-old woman presents to the emergency department with onset


of aphasia and right hemiplegia 2 hours ago. The doctor arrives at 6:00 p.m. and finds the patient globally aphasic with no movement of the right extremities. NIHSS score is 18. CT brain was done before the physician?s arrival and he reads it as normal. Laboratory values including glucose, platelets, and INR are all normal. Her husband is in the room and tells you she has a history of hypertension and atrial fibrillation. Medications include warfarin and altace. She had no prior history of stroke and no recent trauma or surgical procedures. The patient?s blood pressure is 150/90. It is determined the patient is an appropriate candidate for IV tPA.?Risks and benefits of IV tPA are explained to her husband. He consents to proceeding with treatment. The nurse mixes IV tPA and gives her 0.9 mg/kg with 10% as a bolus. She mixes the tPA and draws the bolus into a syringe. The physician administers the bolus and the nurse starts the IV infusion of tPA. The doctor then writes admission orders, dictates a note, and leaves the ED at 7:20 p.m.?His note documents that he personally attended to this critically ill patient for 1 hour 20 minutes including acute stroke evaluation, determining the appropriateness of administering IV tPA, discussing with the family and initiating treatment. This was exclusive of any time spent on E/M services.

 


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Apr 19, 2020

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