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  1. Evaluation 
    • Sudden onset of symptoms (BE-FAST) 
      • Last known normal: <4.5 hours to be eligible for fibrinolytic treatment 
  2. Diagnosis 
    • Rule out differential diagnosis (obtain a BG) 
    • Obtain non contrast CT of head to exclude hemorrhage 
  3. Treatment 
    • Consider past medical history to determine if patient has any contraindications to treatment 
    • If eligible may consider alteplase or Tenecteplase (this may be institution specific) 
    • Monitor for adverse effects
  4. Disposition/monitoring 
    • Admit to ICU for BP and neuro checks