Following rtPA administration during STEMI, which finding would be most concerning?

• A. Abdominal pain
• B. Skin rash
• C. Blurred vision
• D. Altered neuro status

Answer: (D)

The key idea is that thrombolytic therapy with rtPA raises the risk of major bleeding, including bleeding inside the brain. If someone who is receiving rtPA for STEMI develops a change in mental status or other new neurological deficits, that is the most alarming sign because it can indicate an intracranial hemorrhage, a life-threatening complication needing immediate action. In that situation you would stop the thrombolytic, secure the airway if needed, perform urgent neuro imaging (like a head CT), and involve the stroke/neuro team right away.

Abdominal pain could point to potential GI bleeding, but while serious, it’s not as immediately perilous as an intracranial bleed. A skin rash might be an allergic reaction or another drug effect, and blurred vision could have various causes but doesn’t inherently signal the most dangerous hemorrhagic complication.