Walker30613

great read folks...... I guess will take the taoist philosophy with this one - less is better. Patients mentating well vitals are poor, but enough to perfuse the kidneys and brain, infarct on the right side? maybe bezold-jarish which responds to a small gentle bolus by fooling those darn baroreceptors in the pulmonary artery.

Otherwise

ASA

fi02 >.8

a smidgen Atropine if mentation is decreases

and an interventionalist if <60min away

otherwise TNK

and a [s:c3a4e19fcc]bit[/s:c3a4e19fcc] lots of luck.

nothing fancy.... this patient doesnt need an overly aggressive medic wasting time and myocytes, he needs pci/tnk.

thats my thoughts from the cheap seats!

jay

IMO, self-regulation is the most importnat issue in Canada, possibly everywheres else. All the other issues fall into place once self-regulation is achieved. :!:

take care,

Jay

We in Nova Scotia, have just finished a multi-center early thrombolysis vs. early PCI (=hr) vs. early thrombolysis followed by PCI (<24hrs) study. The results demonstrated that early thrombolysis and a cathlab visit within 24 hrs provided for optimum outcomes. *** NOTE: the study was not evaluating prehopital vs. inhospital outcomes*** as there general agreement is that thrombolysis is safe in the prehospital enviroment. The paramedic times were much faster than the inhospital intervals, and the outcomes were simular. But this study has some "gold nuggets" within the data. Anyways, any comments about this study?... weaknesses/strengths?

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PS. The question truly addresses the Canadian perspective as there is not a cath lab at every hospital -mostly at regionalized centers. In saying this, whats is the skill retention of regionalized vs. diluted expertise in cardiac intervention? or is there skill retention or minimal cardiac interventions required to be considered an expert? - this may be an interesting question in itself. lots of questions! so few answers!

take care!

Jay