In message <[log in to unmask]>, Michael
Bjarkoy <[log in to unmask]> writes
>In one trial over 75% of patients who were given thrombolysis
>had cardiographic changes.[18]
Mike, does that mean that 25% of patients given lysis had NO ECG
changes?
You and I have both seen a small handful of cases when you have bought
in a patient with stonking ST elevation on your ECG, but absolutely no
ST elevation (or LBBB) on ours. I'm sure its just a question of gadget
set-up, but has this been satisfactorily done? Current guidelines are
still that lysis should NOT be administered without ECG changes. This is
not ignoring your ECG, its using ours (which we are told is more
accurate).
I'm not against pre-hospital lysis if it can be shown to be safe. I
think your suggestion (off-list) of using a bolus lytic agent (is this
called "front-loading" or "accelerated"??) is a promising practical
suggestion.
The common theme in this thread is how painfully slow lysis can be in
hospital. Unless that can be drastically improved (can someone tell me
WHY hospitals take so long?), then give pre-hospital lysis the
opportunity to improve times.
Dr G Ray
Staff Grade
A&E
Sussex
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