I have a vague memory of reading a case somewhere of a women who had TIA's
associated with the heat of the perm dryer anyone remember the case.
----- Original Message -----
From: john ryan <[log in to unmask]>
To: <[log in to unmask]>
Sent: Monday, March 20, 2000 12:32 PM
Subject: RE: ? Thrombolysis.
> Was this truly an infarct ? Falling asleep as a presenting complaint would
> certainly be unusual in anotherwise presumably independent and ambulant
> patient (given the location of the scenario ie: the hairdressers. Was
there
> any other diagnostic evidence of an infarct or was an old ecg available ?
> Presumably she did have an enzyme rise subsequently in keeping with an
> infarct and evolving changes on her ecg ?
>
> Regards
>
> John
>
> -----Original Message-----
> From: Simon Bell [SMTP:[log in to unmask]]
> Sent: 20 March 2000 10:26
> To: [log in to unmask]
> 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.
>
>
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