Immediately upon walking into your evening shift, a nurse gets your attention and instructs you to see a patient that she is concerned is having a stroke. The patient is a 78-year-old man with a history of congestive heart failure and a mechanical heart valve who has had 2 hours of headache and dysarthria. His family reports that he had no deficits prior to this. You immediately order a head CT, which demonstrates a small right parietal lobe bleed. The INR returns at 4.0 and you notice in the chart that the patient had a recent echocardiogram with an ejection fraction of 15%. You wonder how well he will tolerate reversal and what should be done about his blood pressure, which is 175/105 mm Hg.
To continue reading, please log in or purchase access.