رجل عمره ٦٣ سنة عنده احتشاء STEMI، والممرض يعطيه ألتيبليز لأن مركز القسطرة بعيد. قبل الدواء كان واعياً تماماً. بعد ٢٠ دقيقة صار مشوشاً ويشتكي صداعاً شديداً مفاجئاً، والضغط ارتفع إلى ١٨٤/١٠٠. ما أول إجراء؟

A 63-year-old man with STEMI is receiving alteplase because the cath lab is far away. He was fully alert before the drug. Twenty minutes later he becomes confused with a sudden severe headache and BP rises to 184/100. What is the first action?

1. Give paracetamol and continue the infusion
2. Halve the infusion rate and reassess in an hour
3. Raise the legs and give a rapid fluid bolus
4. Stop the infusion immediately and notify the physician

Answer: D) Stop the infusion immediately and notify the physician. New confusion and severe headache during thrombolysis may mean intracranial haemorrhage. Stop the infusion at once, notify the physician and prepare for brain imaging and reversal per protocol.