Just after a straw poll:
We currently have our criteria for thrombolysis of STEMIs as 1mm
elevation in 2 contiguous limb leads and 2mm in 2 contiguous
precordial leads. I'm dealing with a complaint where the complainants
(amongst other things) are saying we should have thrombolysed the
patient at 1mm in the chest leads rather than watch and wait and then
thrombolysed once they met our criteria.
I've always thought that 2mm was standard but looking at ILCOR from
2005 it now talks about 1mm in the chest leads.
I must admit that I still worry about thrombolysis (figure I've had
around 6 deaths following thrombolysis over the years that i know of
and 3 were very bloody) and would like to be absolutely sure the
patient in front of me was having an MI so feel more confident with 2mm.
What are people teaching their juniors? Have you changed your
guidelines following ILCOR? Do you just run with 'it looks like an
MI' and ignore the amount of elevation?
Thanks
Paul Redman
Frimley Park
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