Question
A patient receiving thrombolysis for PE suddenly developed altered mental status. What is the first step?
| A. |
Administer vitamin K
|
| B. |
Perform a head CT scan
|
| C. |
Start mannitol infusion
|
| D. |
Stop the thrombolytic and observe
|
Show Answer
|
Correct Answer » B
Explanation
|
|
Patient is on thrombolysis (e.g., tPA)
Sudden altered mental status → suggests intracranial hemorrhage (ICH), a known life-threatening complication
First Step Principle
- Always confirm diagnosis before treatment in suspected intracranial bleed
- The fastest and most appropriate initial investigationis:
CT scan head (non-contrast):
-
- Rapidly detects intracranial hemorrhage
- Essential before initiating specific therapy (e.g., reversal, mannitol)
Explanation of Other Options
A. Administer vitamin K
- Used for warfarin reversal, not thrombolytic-related bleeding
- Not first step without confirmation
C. Start mannitol infusion
- Used for raised intracranial pressure
- Should be given after confirming diagnosis
D. Stop thrombolytic and observe
- Stopping drug is important but not sufficient
- Needs urgent diagnosis, not observation
