FIELD REFERENCE
Full criteria & treatment guidance
Indications
- Authorized continuation of an existing alteplase infusion during IFT under PR-233. Activase is labeled for acute ischemic stroke, acute MI and acute massive PE; this does not authorize field initiation.
Contraindications & local exclusions
- Activase exclusions common to its indications include active internal bleeding, recent intracranial/intraspinal surgery or serious head trauma, bleeding diathesis, severe uncontrolled hypertension, or intracranial conditions increasing bleeding risk. Stroke treatment additionally excludes current intracranial or subarachnoid hemorrhage; MI/PE labeling additionally excludes recent stroke. These are indication-specific prescribing restrictions, separate from IFT stop criteria.
Precautions
- Monitor for bleeding and hypersensitivity. PR-233 stop triggers include new altered consciousness, headache, uncontrolled vomiting, SBP above 180, DBP above 110 or seizure. Cathflo alteplase for catheter clearance is a different product/use.
- These are selected safety checks, not a complete prescribing monograph. Product labeling and OCEMS authorization answer different questions; confirm the actual product, patient population and applicable order.
Scope & authority
- This page covers alteplase/tPA continuation under PR-233, not field thrombolysis or another thrombolytic product.
- Keep the stop criteria visible throughout monitoring.
Adult / adolescent
- Receive the sending team’s report: drug, dose, infusion rate, start time, destination, and transfer records. Record baseline consciousness, rhythm, heart rate, and BP.
- Use a transport infusion pump at the rate prescribed by the sending RN/physician. PR-233 does not authorize selecting a new thrombolytic dose in the field.
Pediatric
- No separate pediatric dose or field-initiation pathway is provided. Pediatric use must be governed by the treating team and transport authorization; do not extrapolate an adult stroke regimen.
Pediatric dosing availability
- Use the sending team’s patient-specific transport order and authorized scope. OCEMS does not provide an independent pediatric initiation regimen for transport medications.
| Weight | OCEMS pediatric dose |
|---|---|
| Any weight | No general OCEMS pediatric dose is listed; follow the applicable order or medical direction. |
Use, monitoring & documentation
- Assess BP, heart rate/rhythm, and consciousness every 5 minutes. Protect the patient from injury during handling because hemorrhage is a major risk.
- Immediately stop for new altered consciousness, a new headache, uncontrolled vomiting, systolic BP above 180, diastolic BP above 110, or a focal/generalized seizure.
- Record findings and the stop time; proceed to the receiving facility and report the event immediately on arrival. New bradycardia prompts immediate reassessment of vitals and consciousness.
VISUAL FIELD REFERENCE
IFT alteplase: monitor → recognize stop criteria
Adult & pediatric scope · IFT-ALS
Authorized interfacility continuation only; not field initiation.
Continue the prescribed infusion
Use a transport infusion pump at the rate prescribed by the sending RN/physician. PR-233 does not authorize selecting a new thrombolytic dose in the field.
Monitor every 5 minutes
Assess BP, heart rate/rhythm, and consciousness every 5 minutes. Protect the patient from injury during handling because hemorrhage is a major risk.
Stop for any listed trigger
Immediately stop for new altered consciousness, a new headache, uncontrolled vomiting, systolic BP above 180, diastolic BP above 110, or a focal/generalized seizure.
Document and hand off
Record findings and the stop time; proceed to the receiving facility and report the event immediately on arrival. New bradycardia prompts immediate reassessment of vitals and consciousness.
- This page covers alteplase/tPA continuation under PR-233, not field thrombolysis or another thrombolytic product.
Selected checkpoints; read the complete guide for criteria, exclusions, doses, and ongoing care. PR-233
UNDERSTAND THE CARE
Why the exact thrombolytic and the stop criteria matter
This reference covers continuation of alteplase/tPA, not initiation in the field or substitution of another thrombolytic. Before departure, reconcile the sending team’s order, product, concentration, infusion stage, pump and line. The transfer record should make prior treatment and the remaining prescribed infusion clear.
Applying the guidance
Use the procedure’s monitoring and explicit stop criteria throughout transport. Record the baseline neurological and clinical findings so a new change can be identified and communicated promptly. If a concern develops, follow the applicable stop and medical-direction instructions rather than treating completion of the infusion as the overriding goal.
Diagram text & teaching checkpoints
- Product
- Alteplase/tPA under the specified transport procedure.
- Order
- Concentration, stage, pump and remaining infusion.
- Baseline
- Neurological findings and bleeding assessment.
- Change
- Apply stop criteria and medical direction.
Sources for this explanation
Original OCMedic teaching synthesis of the references below. Educational expansion updated ; this is not a new independent clinical-review date. Source-specific dates and limitations remain in the full guidance.
Establish the baseline before the pump handoff
The transfer report should make it possible to distinguish a pre-existing deficit from a new change during transport. Record the patient’s level of consciousness, vital signs and rhythm when transfer begins, along with the prescribed rate and infusion start time. Verify the receiving destination and transfer records while the sending clinician is available to resolve discrepancies.
When moving the infusion to a transport pump, confirm the actual prescription and functioning infusion system rather than selecting a dose from a stroke-treatment chart. This procedure covers continuation of the sending team’s alteplase infusion; it does not authorize initiating or substituting a thrombolytic.
A new headache during transport is an example of why the baseline matters: PR-233 lists a headache not present previously among its immediate-stop triggers. Document the new finding and stop time, then follow the procedure’s transport and report instructions. Do not rewrite the event as routine completion of the infusion. Include the final neurologic and circulatory assessment at transfer so the receiving team can compare it with departure.
Sources: PR-233