3 ms·
Whilst angioplasty or clot retrieval is the optimal treatment (have not seen evidence for clot retrieval for strokes in longer timeframes but will be interested
by robbiep 9y ago
Whilst angioplasty or clot retrieval is the optimal treatment (have not seen evidence for clot retrieval for strokes in longer timeframes but will be interested to jump into some research tomorrow) in countries where there are enormous distances between tertiary referral centres (ie Australia) thrombolytic agents are still strongly used.
Our ambulances are equipped with r-tPA or similar (there is a tendency to avoid streptokinase as rural/indigenous populations have high exposure to streptococcus/hx rheumatic fever and therefore high risk of added complications) and in the event of STEMIs can be administered en route to ED. Similarly many peripheral sites will administer tenecteplase or similar in Emergency Departments as there are almost no sites that are set up to perform out-of-hours angioplasty once you are out of the major cities; even less chance for neuro-radiological intervention, I think there are only 6 or 7 sites in the country and they are all in major cities.
If his research does bear fruit, I could see it immediately becoming the standard of care in Australia outside of major centres
- thomasfedb 9y agoI'm a volunteer ambulance officer in Western Australia. We certainly don't carry thrombolytic agents. What we do have though is a protocol for getting stroke patients (with good predicted outcomes) into a helicopter or fixed-wing aircraft ASAP so they can get to a hospital with a thrombectomy (clot retrieval) service. If called promptly, then there shouldn't be many patients that we can't get to the right care within a suitable timeframe.
- autokad 9y ago> "If called promptly, then there shouldn't be many patients that we can't get to the right care within a suitable timeframe." I worked with stroke centers, doctors, etc in building stroke access systems, and that doesn't fly with reality. Number 1, is that its hard for patients to recognize they are having a stroke. so "If called promptly" is a bit of unrealistic idealism. Although they say 4 hours, tPA administered after 1 hour has lost most of its benefit, and places that can do thrombectomy 24/7 (in US dedicated stroke centers) is not numerous. You are losing a lot of that hour just for time for the helicopter to warm up, find a spot, and land + your ambulance time getting to /stabilizing the patient. I'm sure the patients on your beat had suitable access, but that's a bit of selectivity bias no? In the US, although the majority of the population is within the golden hour, there are still a ton of population that does not have access to a stroke center. I find it extremely hard to believe that this is not the case in Australia - where I have heard stories of people getting a finger cut off and having to drive 3 hours to the nearest hospital.
- thisrod 9y agoRemember that Australia is ridiculously urbanised. About 80% of Western Australians live in Perth. Contrasted to the US, the most remote Australians must be a lot further from a referral hospital, but the median Australian might actually be closer.
- thisrod 9y agoIs there any possibility that Australia would allow volunteers to administer drugs this dangerous, no matter how effective those drugs were? Not to be rude—I volunteer for an emergency service too.
- thomasfedb 9y agoAsprin, paracetamol, glucose, adrenaline (epinephrine) auto-injectors, salbutamol, glyceryl trinitrate (GTN), methoxyflurane, ondansetron, cophenylcaine (lidocaine + phenylephrine) - that's our volunteer drugs in WA. We're hoping that eventually ketamine will be added. I don't see tPA ever being on that list.
- robbiep 9y agoThat's interesting. Where I trained (central coast, Hunter New England) they do but only for STEMIs, administering'should' occur after a scan in the Ed otherwise