> Is the pain relevant?, if you have clear evidence of MI, and
> no known reason
> not to thrombolyse, then why treat patients differently. How
> quick were they
> into the CAT Scan is will adversely effect the outcome from
> pain to needle
> times and the longer the myocardium is deoxygenated an intact
> brain is not
> going to help.
Because in the studies, the patients who benefitted were those with both a
history of chest pain and certain ECG changes, not those with either no
chest pain or a normal ECG. BTW, in strokes it is not just haemorrhagic
strokes who do worse with thrombolysis- thromboembolic strokes with certain
CT changes (which means a lot of thromboembolic strokes which is part of why
there isn't a huge amount of thrombolysis for stroke) including oedema do
worse with thrombolysis. So in this case I might think: good history,
typical ECG (might be swayed by site of infarct), probably some cerebral
oedema and a bit of trauma from ETT and CPR but on the whole risks outweigh
benefits; whereas without a good history I might think differently on risk/
benefit. Mind you, on a different day I might come down on the other side of
the fence. The subgroup analyses that would tell us what to do aren't out
there. Too easy to go down the line of MI= thrombolysis good instead of MI=
in most patients benefits outweigh risks.
How long were they down for that they needed intubation? Sounds like an
adverse prognostic factor and relative C/I to thrombolysis (due to
likelihood of cerebral capillary damage)
Matt Dunn
Warwick
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