Fibrinolytics/Thrombolytics

[ukcanuck]

COD was MI and opinion of coroner was that PHT or PCI would not have saved pt. There was no evidence of adverse reaction or complication to the PHT.

My service has a cardiac care nurse who coordinates the cases and follows each one up as a quality control to ensure that it was an MI and to follow any adverse reactions. He also gets feed back from the ER/CCU.

Didn't make me feel any better but I put it into context that I have treated trauma pts where I have decompressed their chest gave them fluids drove really fast to hospital and did all the trauma stuff and they still died due to their injuries this was just not as obvious as a FUBAR pt

Still advocate PHT unless you are around the corner from PCI but even that has a complication and death rate

To be honest I am surprised that you guys aren't doing it considering that it is common for RSI in the field over there and I would put that down as a risker skill set to perform well. If you are good enough to do that then you are good enough for PHT for sure!!!

[FL_Medic]

it's a risk/bennifit thing, not a question of skill.

[AZCEP]

Between the differences in education and available facilities, this may well be an apples to oranges comparison.

We tend to have more PCI capable facilities with medical directors that would prefer a delay to definitive care, than to extend the education that is already in place.

[Walker30613]

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?

WEST PDF

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