Re-read the original post if this was ST elevation in the inferior leads
with
reciprocal changes in ALL anterior leads was this in fact an inferior with a
posterior component? If so some form of intervention would be even more
appropriate (as it would likley be a bigger infarct). We would have to see
the ECG to know - were posterior leads done?
Simon
Simon Carley
SpR in Emergency Medicine
Hope Hospital
Salford
England
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-----Original Message-----
From: Mark Dawes <[log in to unmask]>
To: [log in to unmask] <[log in to unmask]>
Date: 12 November 1999 23:39
Subject: Thrombolysis Dilemma
>Dear all
>
>I would welcome your opinions on the following case.
>
>A 59 year old lady with a PMH of asthma, presented to A&E at 23.51 hrs via
>ambulance with a 30mins history of central crushing chest pain of rapid
>onset, with radiation to left arm and jaw.
>All relevant observations were carried out, oxygen therapy continued and 12
>lead ECG obtained.
>
>BP 135/70 Pulse 84 RR 18 SpO2 100% (with 4l O2)
>
>ECG showed 2-3mm elevation in the inferior leads and reciprocal changes in
>all the anterolateral leads.
>
>Aspirin 300mg, Nubain 10mg and Metoclopramide 10mg had been given by the
>paramedic crew. The patient was still distressed in A&E and received
>Diamorphine 5mg.
>She seemed an excellent candidate for Streptokinase but on questioning for
>contraindications, she admitted to having right cataract surgery 2 weeks
>ago.
>This caused the dilemma of whether or not to give her Streptokinase therapy
>in the department as our guidelines suggest that it is contraindicated in
>those who have undergone any operation in the past 6 weeks.
>The medical SHO advised against thrombolysis and the patient was
transferred
>to CCU.
>
>My questions are-
>1) Would any of the group have gone ahead and Strep'd anyway?
>2) Are there some surgical procedures that should only be a relative
>contraindication?
>3) Should the patient be given the option of whether to be treated,
with
>the risks to her sight being explained? (The
>CCU didn't give the patient the option - as they felt it was unfair to
>place a decision that she may not fully understand the implications of on
>her).
>
>I felt that the possibility of losing the sight in one eye was less
>detrimental to her overall health than having a large segment of damaged
>myocardium!!??
>
>I look forward to receiving your comments.
>
>Mark Dawes
>Charge Nurse
>A&E Dept, Manor Hospital, Walsall
>
>
>
>
>
>
>
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