Sunil,
Sounds like you should stay in a teaching hospital.
Dpw ***
> ----------
> From: Sunil Dasan[SMTP:[log in to unmask]]
> Sent: 25 June 2000 12:14
> To: [log in to unmask]
> Subject: What would you do?
>
> I've had a patient in resus recently who posed a bit of a problem and I'd
> be
> interested to hear other peoples views on his management.
>
> This chap was a known arteriopath who had gone to a local community
> hospital
> for ongoing eye follow-up and whilst there he had a routine ECG. It
> showed
> ST elevation 4mm in V2 and 3. He was then sent to A&E. He had the
> tiniest
> niggle of discomfort in his chest an hour before that had lasted five
> minutes but in A&E he had no pain and was sitting there happy as a sand
> boy!. Nor had he had any significant episode of relevant symptoms within
> the last 48hrs.
>
> Question: Would you have thrombolysed him purely on the ECG as he had no
> contraindications?
>
> Repeat ECGs showed that his STs came down over the course of an hour but
> even then were approx 2mm above baseline. Anyway, what did I do.
> Thankfully I'm in a teaching hospital at the moment and so I referred him
> to
> a cardiologist who arranged angiography which showed 95, 90 and 90%
> stenoses
> and he's had a CABG 4 days later!. Good for him that he didn't pitch up
> at
> a local DGH without these facilities.
>
> My question is how rigidly do people stick to the thrombolysis criteria?
> Another lady I saw had Acute LVF but no chest pain but had a
> thrombolysable
> ECG and we dithered until her second ECG showed hyperacute changes (when
> her
> first one just had 2mm and 3mm elevation anteroseptally) that we gave her
> rTPA.
>
> If someone has a thrombolysable ECG but not a classical history but your
> gut
> feeling is that they are infarcting would you thrombolyse?. My last job
> was
> in a DGH and I'm not sure he would have had the same treatment there.
>
> Anyway, I'll leave it there and await any comments. Sorry I've rambled so
>
> much but I'm a 'first time caller' and got a bit carried away!
>
> And by the way 'Hello' to anyone that knows me!
>
> Sunil Dasan, SpR, South West Thames
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