Question: Case Emergency Department Note BH Is A 74 Year Old African American Male Who Was At A Funeral And Had Sudden Onset Weakness At 12:30pm. Bystanders Called 911 And BH Arrived At The Hospital At 13:05 PMH: COPD, HTN, Depression, BPH Meds: Advair 250/50 I Inh Q12h, Hydrochlorothiazide 12.5 Mg Po Daily, Valsartan 160 Mg Po Daily, Tamsulosin 0.4 Mg Po Daily. …

Case Emergency Department Note BH is a 74 year old African American male who was at a funeral and had sudden onset weakness at 12:30pm. Bystanders called 911 and BH arrived at the hospital at 13:05 PMH: COPD, HTN, depression, BPH Meds: Advair 250/50 i inh Q12h, hydrochlorothiazide 12.5 mg po daily, valsartan 160 mg po daily, tamsulosin 0.4 mg po daily. escitalopram 10mg po daily, metoprolol succinate 100 mg po daily FH: Mother died of breast cancer, father died of unknown cause. SH: EtOH-socially, denies illicit drug use, tobacco-20 pack year history, but quit 33 years ago. CT: no hemorrhage NIHSS-19 PE: VS: BP 160/98mmHg, HR 64 bpm, RR 14 bpm, O2 sat: 100% on room air, afebrile, 118 kg, 5’9″ Gen: Obese male in NAD Neuro: Drowy, oriented to person. Responds to voice. Receptive and expressive aphasia HEENT: EOMI, PERRLA, face symmetrical, tongue deviates to left. Ext:LUE/LLE: 5/5 strength; RUE 3/5 RLE: 2/5 strength, CN II-XII intact Skin: Warm and dry, no skin breakdown Lungs: Clear Wine cough CV: Normal sinus rhythm Abd: Soft, NT/ND Labs: Na: 137 K 4.1 CI 105 HCO3 23 BUN 9 SCF0.2 Glu 132 Tchol 178 LDL 117 HDL 56 TG 47 WBC 6.4 Hgb 11.6 HCT 34.8 Plt 332 PT 14.6 INR 1.11 PTT 37 AST 35 ALT 44 CK 99 1. Is the patient eligible to receive IV t-PA? If so, what dose of IV t-PA do you recommend in this patient? 2. What is the patient’s BP goal? Does he require pharmacologic management of the BP? What drug do you recommend? 3. 48 hours later the patient is stable. He has an NGT placed for feeding and medication administration. Can his home medications be administered via the NGT? Can medications for secondary stroke prevention be administered via the NGT? If medications cannot be administered via NGT, what can be done?