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Whop pulls the tpa trigger?

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Who does this at your institutions? Ed alone? Ed discuss with neuro? Call of admission and let hospitalist and neuro decide? I always thought this was an Ed made decision with the pt.

Case

61 y/o female with htn and dyslipidemia, brought in by daughter for acute expressive aphasia. No motor defecits. But cannot speak. Can form words in her head, can sluggishly move tongue, but no words will come out. I am called for admission. 2:40 min into window.

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Whop pulls the tpa trigger?

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