In Leicester stroke unit is on a different site from ED.
Ambulance service do FACES score and transport direct to stroke unit
(but only office hours thrombolysis). Some disagreement between
neurologists (some fo whome do not support stroke thrombolysis) as
perfusion scans not performed (just plain CT) - I haven't looked it up
so I would be grateful for any views about the type of scan needed (I
note that the Australian model specified a perfusion scan).
ED patients here do not have thrombolysis available - but there are
plans to co-locate stroke unit and ED, so we will then do ROSIER at
triage.
My guess is that it will be a bit like the introduciton of thrombolysis
for STEMI. At first considered a dangerous procedure that only a
specialist can undertake, then the evolution of the understanding that
the ED is the most efficient place to carry out the intervention.
Tim.
-----Original Message-----
From: Accident and Emergency Academic List
[mailto:[log in to unmask]] On Behalf Of Andrew Stearman
Sent: 14 November 2007 23:54
To: [log in to unmask]
Subject: Re: Thrombolysis in stroke
I can give you an Aussie perspective
we have a very keen group of neurologists involved in multicenter
thrombolysis trials.
An acute stroke neurology on call roster at consultant level they use
the stroke research nurses to be on call and they attend the ed for any
patients who may be suitable for thrombolysis ( 24/7) ( they can be
called direct from triage and often see patients before any doctors )
the ambulance has a bypass protocol to the tertiary referral hospital
for acute stroke ? thrombolysis but they have to contact the on call
neurologist on scene to authorise the bypass .( to stop the ED from
being swamped ) CT ( perfustion scans ) are usually rapidly avalible
despite all this they dont get many , I think about 10-15 a year ( for a
catchment of 500000 people and total ED attendances of > 100000 for all
local hospitals )
contact me off list if you want any of the protocols
regards
Andy Stearman
John Hunter ED
NSW
>>> Chris Kirke <[log in to unmask]> 14/11/2007 5:16 am
>>>
We are in the early stages of planning to introduce thromblysis for
stroke
in my trust. Does anyone on the list have experience with this, or know
who
does? (I think Steve Meek said last year that his hospital thrombolysed
strokes.)
Regards
Chris Kirke
Whiston ED, Merseyside
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