Trying desperately not to get drawn into the specifics of stroke management
at this stage, I think Matthew's more general point should at least be
considered. However getting ambulances to triage patients to "ward versus
A&E" strikes me as requiring a "leap of faith" way beyond my current
experience of the ambulance service, who seem to have difficulty in suggesting
self-care or GP-care to many of my patients. Why not start at the slightly more
achievable end of the spectrum, and simply get GP-expected patients to go
straight to the ward? After all, they've already been assessed by a
GP, who should've commenced any urgent treatment. If we could achieve this
first, then we may not need to lose our 999 calls as well; besides we
should be careful to keep some work in our departments!
But returning to strokes (I couldn't resist), if "strokes are strokes" in
my homeland, that most western isle of Europe, then why not send at least
some of them home? GPs still, I believe, in some parts of the
country, treat certain stroke patients at home where there is adequate
care, and where acute medical intervention either is not planned or is
contra-indicated. It's a logical extension of Matt's argument really; if we're
not going to do anything for a stroke patient, then there's little point in
admitting them. This might also hold true for the younger patient with a small
stroke but for converse reasoning; while they need to be worked
up, CT, echo, doppler etc, this can often be done as an
outpatient.
Adrian Fogarty
----- Original Message -----
Sent: Monday, December 02, 2002 2:28
AM
Subject: Re: See and Treat
I have a question about
this statement. Wouldn't this patient benefit from a head CT to determine
whether or not this is a hemorrhagic versus non-hemorrhagic stroke? The
treatment may be vastly different. I know in the US we tend to be excessive in
our use of tests and at times overly aggressive in our treatment strategies. I
would like to understand the difference in this case.
In the US a
patient like this would definitely go to the ED for a head CT and if the
stroke was found to be hemorrhagic in nature they would then have an
angiography to determine whether the patient had an aneurysm amenable to
surgical treatment.
Renee