In our institution, approximately 30% of acute MIs are
not 'barn door'and require either discussion with a
senior in the department if not already involved
(Reg/Cons) or joint discussion with the cardiology
team in the hospital.
If you are going to thrombolyse in A&E...then you must
have a clear strategy for dealing with these difficult
cases.Ease of access to senior medical support is
essential (failure to do so will make the Clinical
Governance risk management banner fly in the future).
20 minutes or so talking to all the relevant people
(Med Reg/ cons, cardiologist at tertiary centre and
opthalmology Reg....as mentioned previously)is
probably time well spent in difficult cases. If the
patient is being considered (or not) for thrombolysis
in A&E by the medical SHO then a bit of gentle coaxing
to discuss with a senior would be appropriate in all
cases of NON -barn door MIs.
The options for access to angioplasty might not be
feasible but you don't give the patient a choice if
you don't talk to the centre.
Taj
=====
Dr Taj Hassan
Consultant in A&E Medicine
Dept of A&E Medicine
Leeds General Infirmary
Leeds LS1 3EX, UK
Tel : (0113) 292 6470 Fax : (0113) 292 2810
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