Carolinas Core Concepts Core Concepts in EM; a repository for Carolinas lecture summaries.

28Sep/111

tPA Informed Consent for Ischemic Stroke

Andrew Asimos, MD

  • If a stroke patient is judged by the physician to be incapacitated regarding decision making, under the doctrine of implied consent, the law will assume the patient consented to the treatment for the emergency situation, which includes the administration of IV tPA within the published evidence based guidelines.
  • When a patient cannot provide a true informed consent for tPA due to the exigencies of the situation, every state allows the physician to make the decision for the patient under it "emergency doctrine" -- importantly, neither spouse, child, or other family members get to make the decision
  • The standards for medical decision-making capacity vary from state to state, but generally are based on 4 abilities: to understand the relevant information about the proposed treatment, to appreciate their situation, to reason to make a decision, and to communicate their choice
  •  For a patient to be deemed to have been informed regarding treatment with tPA, the following four areas must be addressed: an explanation of the condition of an ischemic stroke, the nature of the thrombolytic treatment, alternative measures of treatment, and the inherent risks of treatment, which include a 6% risk of symptomatic hemorrhage and the rare risk of an allergic reaction or systemic bleeding
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