INTRAVENOUS GTN PRESCRIPTION FORM: INFUSION Pre thrombolysis and for 24 hours post - thrombolysis – Target systolic BP: 161-180mmHg If systolic BP is If systolic BP is If systolic BP is If systolic BP is >180 between 161-180 Between 140-160 <140 Increase the GTN Continue current Reduce the GTN Stop the GTN infusion infusion rate by infusion rate infusion rate by 5 micrograms/ min 5 micrograms/ min Doctor’s Sign: Date: Intended start time: Haemorrhagic stroke (started within 6 hours of stroke onset) Target systolic BP: 130 -140mmHg If systolic BP is If systolic BP is If systolic BP is If systolic BP is >140 between 131-140 Between 120-130 <120 Increase the GTN Continue current Reduce the GTN Stop the GTN infusion infusion rate by infusion rate infusion rate by 5 micrograms/ min 5 micrograms/ min Doctor’s Sign: Bleep: Date: Intended time: Daily senior physician review to confirm that ongoing GTN infusion is appropriate Date: Drs signature:
INTRAVENOUS GTN PRESCRIPTION FORM: INFUSION Pre – thrombolysis and for 24 hours post - thrombolysis Target systolic BP: 161-180mmHg If systolic BP is >180 If systolic BP is between 161-180 If systolic BP is Between 140-160 If systolic BP is <140 Increase the GTN infusion rate by 5 micrograms/ min Continue current infusion rate Reduce the GTN infusion rate by 5 micrograms/ min Stop the GTN infusion Doctor’s Sign: Date: Intended start time: Haemorrhagic stroke (started within 6 hours of stroke onset) Target systolic BP: 130 -140mmHg If systolic BP is >140 If systolic BP is between 131-140 If systolic BP is Between 120-130 If systolic BP is <120 Increase the GTN infusion rate by 5 micrograms/ min Continue current infusion rate Reduce the GTN infusion rate by 5 micrograms/ min Stop the GTN infusion Doctor’s Sign: Bleep: Date: Intended time: Daily senior physician review to confirm that ongoing GTN infusion is appropriate Date: Drs signature:
Intravenous%20GTN%20Prescription%20%20-%20Infusion%20v1.1.docx