Fibrinolytics/Thrombolytics

[AZCEP]

Transport times of greater than 1 hour was not where I was going, but it is a good point.

The utility of the fibrinolytics for AMI, and AMI only, can be up to 6 hours from symptom onset. This usually means the patient denies the symptoms for a while, then calls for help, and arrives at a facility beyond the recommended time frame. For those that have PCI facilities available, withholding the fibrinolytic is a reasonable measure.

The use in CVA, can be extended to 6 hours, but it must be given intra-arterial at the site of the occlusion. Tough to do this in the prehospital environment. Pulmonary embolus and DVT, might be reasonable opportunities to use them prehospital, but the severity of the occlusions would have to be graded beforehand, again tough to accomplish.

I will agree that for some situations, there is nothing better. At the same time, for the wrong situation, there could be few things worse.

[Just Plain Ruff]

ACE I agree get your ass back in school and get your medic. But I think you have more important things to do in life and you have yet to start.

[Ace844]

ACE I agree get your ass back in school and get your medic. But I think you have more important things to do in life and you have yet to start.

I'm working on finishing except I keep hitting speed bumps which has been extending my time to finish...work in progress, maybe I wouldn't have the 'non-personal situation' related delays if I had gone to a 'cook book' school, but even with all the extra time and headache, I wouldn't trade my education, or experiences in my program thus far for the world.. Thanks for the vote of confidence.

ACE

[AZCEP]

I'm going to suggest skipping the paramedic thing altogether.

Go to MEDICAL school instead, jock-o. Just remember where you came from.

[Ace844]

I'm going to suggest skipping the paramedic thing altogether.

Go to MEDICAL school instead, jock-o. Just remember where you came from.

Thanks for the vote of confidence, I haven't really thought about medschool all that much, certainly soemthing i will consider for the future though, thanks,

ACE

[FL_Medic]

Transport times of greater than 1 hour was not where I was going, but it is a good point.

The utility of the fibrinolytics for AMI, and AMI only, can be up to 6 hours from symptom onset. This usually means the patient denies the symptoms for a while, then calls for help, and arrives at a facility beyond the recommended time frame. For those that have PCI facilities available, withholding the fibrinolytic is a reasonable measure.

The use in CVA, can be extended to 6 hours, but it must be given intra-arterial at the site of the occlusion. Tough to do this in the prehospital environment. Pulmonary embolus and DVT, might be reasonable opportunities to use them prehospital, but the severity of the occlusions would have to be graded beforehand, again tough to accomplish.

I will agree that for some situations, there is nothing better. At the same time, for the wrong situation, there could be few things worse.

There is no use for it in a prehospital setting for CVA, we would never be able to exclude a bleed. But with the right education I think we might be able to get it into the right systems.

What about in regards to my original post, regarding it adding difficulty to a surgeons job?

[AZCEP]

Yes, we can exclude a bleed. It is a bit more detective work, but it can be done.

The information you need can all be gathered from the history to be reasonably sure a bleed is not happening.

More times than not it would be ruled out, instead of in, but prehospital the three hour window for ischemic CVA is much more achievable than it is for the hospital.

It will never be approved for CVA, but if it is acceptable to use for AMI, one can only hope.

[Spock]

I think I can shed some light on your concerns about thrombolytics and the OR since I work as a CRNA and cardiac surgery along with trauma are my specialties. You cannot imagine the problems we have with bleeding when we do an emergency CABG on a patient that received thrombolytics. Since none of the EMS services in the Pittsburgh area carry thrombolytics the scenario is usually a patient that went to an outlying community hospital, got the clot buster and then got a helicopter ride to our cath lab. So far so good. What creates a problem is if they can't stent the occlusion or they dissect a coronary artery. Then the patient goes for emergency CABG and bleeds like stink. We have to give platelets, FFP and cryoprecipitate to control it and sometimes we even give DDAVP. It's a given the patient will get multiple units of RBC's.

Unfortunately I am a twisted and demented SOB who thinks these cases are fun. Of course that's why when one of these cases comes up the charge person assigns me to the case and if I am in charge I assign myself. I guess that makes me a masochist as well.

Back on topic. I don't believe the literature supports thrombolytics in the field unless transport times are long. Rapid transport to a hospital with emergency cath lab capabilities is the best treatment. Activation of the cath lab team after hours prior to EMS arrival at the hospital is ideal. My hospital will call in the cath lab team after hours if EMS sends a 12 lead showing an acute infarction and will send the EMS crew straight to the cath lab bypassing the ER.

Live long and prosper.

Spock

[FL_Medic]

Yes, we can exclude a bleed. It is a bit more detective work, but it can be done.

The information you need can all be gathered from the history to be reasonably sure a bleed is not happening.

More times than not it would be ruled out, instead of in, but prehospital the three hour window for ischemic CVA is much more achievable than it is for the hospital.

It will never be approved for CVA, but if it is acceptable to use for AMI, one can only hope.

resaonably sure does not exclude a bleed. sure we can look for S/S, but not all pt.s present the same way, and imagine having a small undetectable bleed and throwing in a clotbuster.

[FL_Medic]

I think I can shed some light on your concerns about thrombolytics and the OR since I work as a CRNA and cardiac surgery along with trauma are my specialties. You cannot imagine the problems we have with bleeding when we do an emergency CABG on a patient that received thrombolytics. Since none of the EMS services in the Pittsburgh area carry thrombolytics the scenario is usually a patient that went to an outlying community hospital, got the clot buster and then got a helicopter ride to our cath lab. So far so good. What creates a problem is if they can't stent the occlusion or they dissect a coronary artery. Then the patient goes for emergency CABG and bleeds like stink. We have to give platelets, FFP and cryoprecipitate to control it and sometimes we even give DDAVP. It's a given the patient will get multiple units of RBC's.

Unfortunately I am a twisted and demented SOB who thinks these cases are fun. Of course that's why when one of these cases comes up the charge person assigns me to the case and if I am in charge I assign myself. I guess that makes me a masochist as well.

Back on topic. I don't believe the literature supports thrombolytics in the field unless transport times are long. Rapid transport to a hospital with emergency cath lab capabilities is the best treatment. Activation of the cath lab team after hours prior to EMS arrival at the hospital is ideal. My hospital will call in the cath lab team after hours if EMS sends a 12 lead showing an acute infarction and will send the EMS crew straight to the cath lab bypassing the ER.

Live long and prosper.

Spock

THANK YOU FOR THIS ANSWER... I know have a better understanding.