Perhaps worth doing a Case Report on the Munchausen Cases. Mind you the
Journal would probably want written consent from the patients.
I kid you not! BMJ Guidelines....
Ray McGlone
-----Original Message-----
From: Accident and Emergency Academic List
[mailto:[log in to unmask]] On Behalf Of Andrew Volans
Sent: 06 February 2011 17:23
To: [log in to unmask]
Subject: Re: Stroke thrombolysis
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
>
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