I would like to know more...
age..
onset of pain..
recent thrombolysis
were all the normal inclusion / exclusion criteria asked prior to
administration
BP and pulse normally - might always have a low BP and pulse because he was
extremly fit
Were all the obs done on an automated unit ??faulty
Dare I say this - do you trust the obs that were taken by the nurse and do
you trust the doctor who assessed the patient. Did they get the history
wrong.
What would I do...
Stop the thrombolysis
seek expert help - wake the cardiac consultant up at 2am they wont mind -
honest. Prof Chamberlain said so.
Revisit the inclusion / exclusion criteria
1. Run in fluid in case there is a bleed? - NO AT THIS TIME
2. Stop the infusion until pulse and bp recovers? - STOP, BUT DON'T WAIT
TILL OBS RECOVER
3. Treat with hydrocortisone and antihistamines? - CONSIDER BUT DON'T
INITIATE YET
4. Treat with atropine? - NO - COULD BE A BLEED - NOT HELPFUL IN THIS
CASE
5. Do nothing? - NO
6. Do something else or a combination of some of the above? YES....
I would treat it as a reaction to the drug.
If the expert thinks it appropriate and all bases have been covered I would
probably opt for TPA with a heparin infusion
Q. What were his CK-MB and Troponin T measurments?
Mike Bjarkoy
Paramedic
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