Hi,
I would just be concerned about delays. How do you know this infarct is
less than 12 hours? The benefit of thombolysis diminushing regularly with
time, and being generally far less for inferior than anterior ones, I would
really question this time frame and the final choice.
Cheers,
____________________________
Alain Vadeboncoeur MD
[log in to unmask]
http://www.urgenet.qc.ca
----- Original Message -----
From: Simon Bell <[log in to unmask]>
To: <[log in to unmask]>
Sent: Monday, March 20, 2000 5:25 AM
Subject: ? Thrombolysis.
> I would be interested in peoples oppinion of the
> following senario:
> We had a 93 yr old lady into A+E who presented with a
> collapse.....she kept "falling asleep" while she was
> having her hair done, so the hairdresser suggested she
> came to A+E. There was no history of Chest pain or
> Diabetes.
> This lady had an ECG showing an acute inferior infarct
> of less than 12 hrs old (likly).
> She was in SR, no failure clinically or on her CXR,
> and was normotensive.
> AS a knee jerk reaction she was given aspirin and
> prepared for thrombolysis with Streptokinase.
> This lady had had a CVA 6 yrs ago with a right
> hemiplegia from which she just about remained
> independant.
> I was coutious about thrombolysing this lady.....not
> becouse of her stroke 6 yrs ago, but I questioned the
> benefit in a lady of this age in terms of added
> morbidity. I am well aware that the elderly do best
> from thrombolysis in terms of coronary flow as
> measured in the TIMI flow studies, but how does that
> relate to added yrs of life given that this lady's
> starting age was 93.
> She was also highly dependant on her left side for her
> independant state and from a cardiac point of view she
> was doing very well, probably just a few peri-infarct
> arrhythmias causing her synptoms in the hairdresser's
> salon. If thrombolysing her is going to do little in
> terms of added yrs of life, why risk making her
> dependant by the possibility of an intracranial event.
> Aspirin alone is still as good as thrombolysis alone.
> Anyway...after great calm debate she was thrombolysed
> and was doing well 2-days later...
> I would like to know:
>
> Was I being overcautious?
>
> Is there evidence for a correct answer to the above
> problem?
>
> What are peoples views?
>
> Dr Simon Bell
> SpR A+E Medicine
> University Hospital Lewisham.
>
>
> __________________________________________________
> Do You Yahoo!?
> Talk to your friends online with Yahoo! Messenger.
> http://im.yahoo.com
>
%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%
|