🚨 Sudden BP Spike Post-tPA = Hemorrhage Until Proven Otherwise

New SBP >180-230 or sudden change from baseline + headache, vomiting, or decreased consciousness?

Immediate actions:

1. HOLD tPA infusion (if running)
2. STAT NIHSS
3. STAT CT head
4. Notify physician NOW

Don't wait. Don't rationalize. Act.