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Stroke Treatment in the ED: 2013 tPA Guidelines (1 credit Monograph)

Hours: 1.00

Best suited for: ED and other physicians, and other clinical staff caring for stroke patients in the ED setting

The timely use of tPA was shown in 1995 to reduce disability from acute ischemic stroke in eligible patients, and the FDA approved its use for this purpose in 1996. Since then, many physicians have continued to have reservations about tPA due to the risk of hemorrhage, and the increase in use of tPA has been gradual. Subsequent evidence emerged, and new guidelines from the American Heart and Stroke Associations and the American College of Emergency Physicians were published in 2013. This monograph will provide a roadmap to the research findings and the new guidelines from a risk management perspective.

Original Release Date: December 19, 2013
Review Date: December 19, 2016
Expiration Date:

Learning Objectives: Upon completion, participants should be able to
a. Describe the evolution of clinical guidelines regarding the use of tPA in acute ischemic stroke.
b. Characterize the quality of evidence supporting the 2013 AHA and ACEP guidelines on the use of tPA.
c. Identify the difference between the ACEP and AHA recommendations regarding the use of tPA within 3 hours of symptom onset and between 3 and 4.5 hours.
d. State what should be done when departing from the ACEP and AHA guidelines on the use of tPA.

Learning Assessment: There will be a post test for this activity with a minimum performance requirement of 5 out of 7 correct answers.

Estimated time to complete activity: 1 hour

Residents will earn a certificate of completion. Physicians will earn CME credit. CME Information - Read

Method and Medium: To obtain CME credit, read the entire monograph online, download to a printer and read, or download and save to your computer. Complete the evaluation and post test and print your certificate online.

CME Credit: 1.0


MOC Approved: Through the American Board of Medical Specialties ("ABMS") and Association of American Colleges' ("AAMC") joint initiative to create a wide array of Maintenance of Certification ("MOC") Activities, 'Stroke Treatment in the ED: 2013tPA Guidelines' has met the MOC requirements as a Part II activity by the following ABMS Member Boards:

  • American Board of Anesthesiology
  • American Board of Family Medicine
  • American Board of Physical Medicine and Rehabilitation



State Requirements: Based on information from state licensing authorities published by the AMA, this program meets specific CME requirements for the following states:
Florida -  This activity includes content in Preventing Medical Errors
Connecticut - This activity includes content in Risk Management
Massachusetts - This activity includes content in Risk Management
Pennsylvania - This activity includes content in Risk Management / Patient Safety
Texas - This activity includes content in Ethics and/or Professional Responsibility

Disclosure Policy - Read

Disclosure:  The author, reviewers, editor and planning committee members for this activity have no relevant financial relationships to disclose.

About the Author and Expert Reviewer - Read Bios
Roy M. Lee, M.D., J.D. and Keith Van Meter, M.D., FACEP

Managing Editor: Dawer Azizi, MHA, CPHRM, LAMMICO Manager of Risk Management

Editor: Sharon Cusanza, MSN, RN, NEA-BC, LAMMICO Senior Risk Management Education Specialist

Content Advisors/Planning Committee Members - Read

Electronic Hardware and Software Requirements - Read

Web Master Contact Information: For assistance, contact Shea Ivey at 866/398-1038 or

Disclaimer: This activity is presented as risk management education.  It is not legal advice, nor does it establish medical standards of care.  Standards of care vary depending on the unique presentation of each patient.  The information contained herein is not a substitute for the reasonable discretion of skilled and informed clinicians at the point of care.

Copyright Information: Copyright © 2013

Bibliography: To view and download a Bibliography for this presentation, please select the References button below.


This course is offered through Experix, a wholly owned subsidiary of Physicians Insurance, and is based on more than 30 years' experience in providing continuing medical education. This course is complimentary for Physicians Insurance members.

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