Thrombolysis
                                ============

þ Prehospital Thrombolysis
  <ThrombPH.TXT>

þ Thrombolysis might be useful in PE, DVT, CVA, Arterial
  Thrombosis
  <ThrombRF.TXT>

þ Risk factors for thrombolysis:
  <ThrmbRsk.TXT>

þ Protocol for Noncoronary Thrombolysis (Sherry)
  - Baseline CBC, PT/PTT, fibrinogen
  - if giving streptokinase, first give hydrocortisone sodium
    succinate 100 mg IV (reduces allergic reactions to less
    than 5%; treat fever with acetaminophen but not a reason to
    stop unless other symptoms of allergy.)
  - Load with 250,000 units of streptokinase over 30 minutes by pump
  - follow by infusion of 100,000 units per hour
  - check fibrinogen in 2-4 hours; should be down significantly
    (often about 50% with streptokinase, more often about 25% down with
    urokinase and tPA)
  - continue for 72 hours or until demonstrated therapeutic
    result
  - titration not useful
  - after completing streptokinase infusion, wait for 3-4 hours, then
    check PTT.  If elevated but therapeutic ()1.5 to 2 times
    control), start heparin at usual doses but without loading
    dose
  - If PTT more than 2 times control, wait another 2-3 hours
    and recheck
  - If PTT near-normal, give small heparin bolus and start
    infusion.
  If resistant to streptokinase, may give urokinase: load with
  2,000 IU per lb. of body wt, then infuse 2,000 IU per lb. per
  hour; may continue as long as needed, because not antigenic.