So the tzars in their infinite wisdom reassure us that longer transfer times
are perfectly safe - and there was I thinking the window of opportunity for
thrombolysis in acute ischaemic stroke was only 3 hrs [and the data suggests
much higher chance of positive outcome if given ASAP], a pretty tight
time-frame even if going to the nearest ED - but what do I know, I'm not a
"specialist" of the type favoured by Roger Boyle to receive these patients.
If Georges' missive pisses you off try Rogers' - he's managed to completely
airbrush out any contribution from EM to the recent improvements to acute
cardiac care. Why does administration of a thrombolytic in AIS need
a"specialist" when most ED's have been administering these drugs in AMI and
to a lesser extent PE for some years?
Clearly these 2 "big guns" have been wheeled out by HMG to soften up the
great British public for their proposed closure/down-grading of ED's - happy
days!
Cheers, Bill
----- Original Message -----
From: "Scott, Charles" <[log in to unmask]>
To: "Bill Bailey" <[log in to unmask]>
Sent: Tuesday, December 05, 2006 2:30 PM
Subject: Re: Thrombolysis for PEs
> Prof Alberti doesn't share your anxieties Rowley as I found browsing his
> report on emergency access at the address below.
>
> http://www.dh.gov.uk/PublicationsAndStatistics/Publications/Publications
> PolicyAndGuidance/PublicationsPolicyAndGuidanceArticle/fs/en?CONTENT_ID=
> 4140903&chk=mXL0z4
>
>
>
>
>
> -----Original Message-----
> From: Accident and Emergency Academic List
> [mailto:[log in to unmask]] On Behalf Of Rowley Cottingham
> Sent: 05 December 2006 12:11
> To: [log in to unmask]
> Subject: Re: Thrombolysis for PEs
>
> I looked at this a year or two back. The 'official' guidelines for PE
> are based on a guess made in a Spanish paper for the doses required for
> alteplase. Essentially, they looked at the then recommended dose for MI
> (If I remember correctly it was around 1991) and used the same dose. MI
> dosing has moved on, that for PEs hasn't. The data is really not
> terribly impressive (I was about to write robust, but as it is the
> current buzzsynonym for everything from 'worth doing' to
> Trust-enforcing-insistence I have banned it from my personal lexicon)
> and could easily be looked at again. There's a nice piece of work there
> we could do as a multiple site group.
>
> I'm very opposed to thrombolysis for stroke - it is really too crude a
> treatment.
>
> /Rowley./
>
>> *From:* "McCormick Simon Dr, Consultant, A&E"
>> <[log in to unmask]>
>> *To:* [log in to unmask]
>> *Date:* Tue, 5 Dec 2006 08:49:56 -0000
>>
>> I suppose that's part of the point I'm trying to make. Alteplase has
>> the licence for PE thrombolysis and its unlikely any other company is
>> going to do the trials necessary to get one so using another
>> fibrinolytic is technically prescribing off licence. Locally we'd
>> rather use a drug everyone is familiar with and we use Reteplase for
>> MIs
>> so it makes sense to stick with that. However, this flies in the face
>> of the BTS guidelines and the licensing so we need to make sure we are
>> not going out on a limb. The consultants are generally happy with the
>> idea but it's the Risk Managers that get twitchy.
>>
>
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>
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