• Usually reversed by elevating the foot of the bed or slowing the infusion

Allergic reaction to streptokinase

• Give chlorpheniramine 10 mg IV and hydrocortisone 100 mg IV (prophylactic treatment not needed)

Oozing from puncture sites

• If venepuncture is necessary, use a 22 G (blue) needle and compress the puncture site for 10 min
• Central venous lines should be inserted via an antecubital fossa vein
• For arterial puncture, use a 23 G (orange) needle in the radial or brachial artery and compress the puncture site for at least 10 min

Uncontrollable bleeding

• Stop the infusion of thrombolytic
• Transfuse whole fresh blood if available or fresh frozen plasma: seek advice from a haematologist
• As a last resort, give tranexamic acid 1g (10 mg/kg) IV over 10 min

Symptomatic bradycardia unresponsive to atropine

• If temporary pacing is required within 24h of thrombolytic therapy, the lead should ideally be placed via an antecubital fossa vein
• If there is no suitable superficial vein, place via the femoral or internal jugular vein with ultrasound guidance (Chapter 116)