I guess this makes a good case for replacing medical SHOs with emergency
doctors in emergency departments !
David Wald had an interesting paper in the journal of A&E medicine last year
which aimed to look at the use of of thrombolysis in AMI when faced with
perceived contraindications to treatment and to explore the justification
for with holding treatment in such clinical situations.
He surveyed 20 doctors involved with prescribing thrombolysis in his
'teaching' hospital. They were given a series of 19 scenarios and asked
whether they would prescribe or withold thrombolysis in the situations. In
all but one of the clinical situations there was wide variation in response
as to what constitutes a contraindictaion to thrombolysis.
He reviewed the evidence and found that witholding thrombolysis in AMI is
often based on intuitive fears rather than evidence. He concluded that " In
order to realise the benefits of thrombolytic treatment in AMI, clinicians
should be encouraged to give rather than withhold thrombolysis in
circumstances where the risks, although unknown, are likely to be small and
far outweighed by the benefit of treatment."
This was surely the case here where common sense should have over ruled lack
of evidence. I mean, who is ever going to have a series of 100 patients who
received thrombolysis for an inf M.I. a few weeks following cataract surgery
?
REFERENCE:
David S Wald
Perceived contraindications to thombolytic treatment in acute myocardial
infarction. A survey at a teaching hospital.
J Accid Emerg Med 1998;15:329-331
----- Original Message -----
From: Mark Dawes <[log in to unmask]>
To: <[log in to unmask]>
Sent: Friday, November 12, 1999 11:38
Subject: Thrombolysis Dilemma
John Ryan
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