In message <[log in to unmask]>, Ian Higginson
<[log in to unmask]> writes
>Wouldn't regard direct admission to CCU as a forward step ....
>
>Surely the best place to recieve acute chest pain patients is ED? The expertise
>of ED units and docs
(and paramedics! - Goat)
>lies in rapid assessment, management and disposition of
>emergency patients. Patients suspected of having MI prehospital frequently have
>other conditions causing their problems, or may not require CCU admission
>/fulfil
>thrombolysis criteria
>
>I would suggest that if your local A&E unit thrombolysis times were an hour
>perhaps the most appropriate line of attack was to look at their systems, rather
>than handing a core part of ED capability on to another service.
I'll 2nd that. Anecdotally I would think experienced docs and nurses in
our A&E can do door-to-needle in 15 minutes (takes 12 minutes to
dissolve the strep!) - MUCH quicker if pre-warned by 999. I'm astonished
at times of 60 minutes reported from elsewhere. If (junior) medics +/-
CCU involved add 20 minutes minimum (I think Dr J Edhouse showed this
sometime ago).
Dr G Ray
Staff Grade
A&E
Sussex
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