Possible options:
1. thrombolyse anyway as regional infarction
2. Wait to see if ST elevation in 2 consecutive leads develops
3. Treat as ACS/ NSTEMI
4. PTCA - yeah, right. Might win the lottery this weekend too!
5. Other
--> I'd try for option 4 and, if I also win the lottery then there's TWO
happy people.
If I failed to get patient to catheter then I will probably wish to
thrombolyse as well, however I am quite conscious of the fact that if you
keep trying more and more leads you're quite likely to find your 2
contiguous ones eventually. The evidence thus far established for
thrombolysis, however, was NOT produced with a protocol including so many
leads... What we need, now that thrombolytic agents AND early ECGs AND good
scientific methodology are ALL very widely available, is for the various
lead subgroups to be analysed separately for benefit/risk ratios.
What do you say - if you thrombolyse and obtain a massive cerebral bleed
with sever permanent consequences and end up trying to justify your actions
- you'd find it a challenge to present evidence for thrombolysing this
patient with the knowledge that the risk is outweighed by the benefits.
Maybe you'd be needing the lottery win... Although, as I said, I'm tempted
too!!!
I'll probably present the case to the patient and tell him "I don't know -
what do YOU wish to have done? Or have YOU just won the lottery..." (in
which case it's option 4 again and he's paying!)
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