Rowley,
Scenario needs the A&E Doc to have bicycle clips firmly in place.
I would assume that it was a reperfusion arrhythmia or brainstem bleed. It really
does not seem like anaphylaxis or other drug reaction, which are also rare
whereas reperfusion arrhythmias are common.
The brainstem bleed this will be fatal and there is nothing that I can do about it
so I would ignore it.
The reperfusion arrhythmia shows that my treatment is working and so should
be continued. Leaving the Strep running is unlikely to make things worse (OK,
OK, I guess in practice i would slow the rate of infusion!). I would also very
much regret not putting in a central line before the thromolysis and consider
putting one in now. I would also very much regret not having followed up on
reading the recent article on ultrasound guided central cannulation, which I
assume may be safer after thrombolysis.
The rate gives a risk of spontaneous VF, but I would probably tolerate it for a
while as these reperfusion arrhythmias usually spontaneously settle. (I have no
definition of "a while"!).
My better half is doing her Cardiology MSc. She will get a Chamberlain/Vincent
opinion of the scenario next week, which I will post.
What did you do? What happened to the patient?
Tim.
Timothy J Coats MD FRCS FFAEM
Senior Lecturer in Accident and Emergency / Pre-Hospital Care
Royal London Hospital, UK.
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