I agree about the EBM approach to therapy, and if we apply to this therapy,
there are problems, especially in the area of reading a CT scan to exclude
subtle haemorrhage (NINDs criteria) or evidence large areas of ischaemia
(ECASS). This tiger country and I personally don't believe the risk/benefit
ratio supports it at this stage. For further info, for those who can access
Emergency Medicine Abstracts, this has been a topic receiving a lot of
discussion, mostly suggesting the evidence does not support routine use at this
time.
Stuart Stapleton
John Chambers wrote:
> Seems topical both in Australasia and the UK at present.
> We have had an American Emergency Physician on sabbatical and discussed
> thrombolysis for strokes last week at our teaching session.
> This has become fairly routine paractice in his institution for evolving and
> progressive strokes within 3 hrs of symptoms - without much fuss.
> Crank up the CT scans, there is no going back in medicine.
> If the evidence supports a therapy it will happen.
> JohnC
>
> -----Original Message-----
> From: Nick Ryan [mailto:[log in to unmask]]
> Sent: Friday, 10 March 2000 10:42
> To: [log in to unmask]; [log in to unmask]
> Subject: Re: strokes and lysis
>
> Shane,
> In the rural centre of excellence we don't lyse strokes. Triage really
> depends on the nature of the presenting complaint. If there was any
> alteration in concious level I would expect them to get a 1 or 2. If it is
> new onset neurological deficit probably 2 depending on circumstances. For
> the 110 yo from the nursing home who is sent in with a letter saying ?CVA
> because he is dribbling a bit more today probably 4 or 5.
>
> Nick Ryan FACEM
> Director, Emergency Department
> Tamworth Base Hospital
> PO Box 83
> Tamworth, NSW. 2340
> email: [log in to unmask]
> phone 0267661722
> fax 0267683367
>
> >>> Shane Curran <[log in to unmask]> 03/09 7:48 pm >>>
> Quick poll before a meeting tomorrow
>
> who is lysing strokes either as part of a trial or not?
>
> What are you triaging strokes as?
> My neurologist is mounting a push to put them on a par with ami's and get a
> 2
> We're trying to convert him to the real world but have no other site data
> beyond what I remember
>
> Dr Shane Curran
> Acting Director
> Emergency Department
> Wagga Wagga Base Hospital
> Wagga Wagga
> NSW
> Australia 2650
>
> 02 69386539(office)
> 02 69386351 ED
> 02 69 386384 Fax
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