Interesting thread. As far as I'm aware, the big unanswered question is
which best dictated benefit from thromobolysis (as opposed to best
prediction of MI)- clinical judgement + ECG interpretation; expert ECG
interpretation or ECG interpretation according to protocols. If it turns out
that protocols are better than expert interpretation at this, it obviates
the need for calling the medical reg/ A and E middle grade/ consultant-
nurses or computers could do the job better and we can all sleep at night
(except nurses). If expert interpretation is better (and there's pretty good
evidence that it is more accurate at diagnosing), then I'm sorry, Andrew,
but the only reason not to fax through to the consultant or call the most
senior resident doctor stat is cost/ benefit.
Matt Dunn
Warwick
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