 |
 |
We in Scarborough do thrombolyse up to 4 1/2 hours but I do not think the results are nearly as good as below three hours. Interestingly there has been a dearth of "lysed" patients in the last three months but the number of patients attending has not dropped so I have a good audit for my new SHO's, those that have turned up that is! Am still trying to get my paper on the first 100 cases treated in Scarborough in the EMJ. Am on the 5th draft now having been told that the message has been lost in the revisions. I think one of the reviewers had it in for me, they want me to reverse all the changes he put in! We do it over the whole 24 hour period now, although in reality the majority present in extended office hours but every day of the week. Now that the treatment is accepted in the trust, it even gets done on wards if patient's stroke there having been admitted for other reasons (including severe TIA) The results on the wards are not as good or as quick as doing it in a pathway in the ED. The CT is pretty easy. The neurologists and Stroke docs would have you believe that the diagnosis is difficult. The majority of ones we have done are simple hemis plus or minus speech dysfunction. The CT needs to be normal or near normal. Being able to identify subtle grey-white demarcation is not really necessary. In our experience the treatment is safe from the ICH point of view provided there is no marked oedema or blood on CT. And yes we have been caught out by two munchausens. one tried it on three times. We did "lyse" one twice. because the stroke team were hyper keen early on. I twigged when she landed on me and her CT showed no changes despite three strokes. We are good but not that good. The majority of our folk have some CT changes at 48 hours even with full resolution of signs. The other was very young and only got a single dose. She now gets sent home with horrific hemi's that disappear as she walks out of the department. Andy V On Thu, 3 Feb 2011 16:17:47 -0000 Andy Webster <[log in to unmask]> wrote: > Our local stroke network wishes to implement the >findings of ECASS 3 to > extend the thrombolysis window to 4.5 hours. What are >colleagues doing > locally? If thrombolysing strokes at all. > > > > So far in four months on a 9-5 service we have managed >to thrombolyse 2. > Don't think we are missing many eligible ones just in a >rural population > they seem to be arriving to late. > > > > Andy Webster >