History
Vitals
Labs
Orders
Notes
67yo female with HTN, AFib (on apixaban, held), hyperlipidemia. Last known well 14h ago. Symptom onset 13h ago — left MCA ischemic stroke, NIHSS 12 on arrival. IV alteplase given 12h ago within the 4.5h window.67歲女性，有高血壓、心房顫動（服用apixaban，已暫停）、高血脂。最後已知正常時間為14小時前。症狀發作於13小時前 — 左側中大腦動脈缺血性中風，到院時NIHSS 12。IV alteplase於12小時前在4.5小時時間窗內給予。
BP 168/92 (1h ago 145/85), HR 88, RR 22, SpO2 95% RA, T 37.0C, GCS 13 (E3 V4 M6, down from 15 one hour ago).BP 168/92 (1小時前 145/85), HR 88, RR 22, SpO2 95%室內空氣, T 37.0C, GCS 13 (E3 V4 M6，較一小時前的15下降)。
INR 1.2, PT 14, aPTT 32, Plt 250K, Hgb 13.4, Glucose 132, Cr 1.0.
Post-tPA protocol: keep BP <180/105, q15min neuro x2h then q30min x6h then q1h x16h. NPO until swallow eval. No antiplatelets, anticoagulants, or invasive lines x24h. STAT non-contrast head CT if neuro decline.施打tPA後照護方案：維持血壓 <180/105，每15分鐘神經學檢查一次持續2小時，之後每30分鐘一次持續6小時，之後每1小時一次持續16小時。禁食直到吞嚥評估。24小時內勿給予抗血小板藥物、抗凝血劑或侵入性管路。若神經學狀況惡化，立即進行無顯影劑頭部電腦斷層。
Mild dysarthria and right arm/leg weakness present since stroke onset (baseline post-stroke, NIHSS 8 after tPA). At hour 12: patient reports worst headache of life, vomited once, eyelids heavy, GCS 13. Cardiology and neurology paged.輕度構音障礙及右臂/腿部無力自中風發作起即存在（中風後基線，施打tPA後NIHSS為8）。在第12小時：病人主訴生平最劇烈頭痛、嘔吐一次、眼皮沉重，GCS 13。已呼叫心臟科及神經科。