Prehospital Thrombolysis For MI

Question 1

When is thrombolysis the preferred method of clot resolution?

Answer 1

When pci is not available within 2 hours of first medical contact (or 90 minutes in early presenters)

Question 2

When is pci used over thrombolysis?

Answer 2

It is available within the time limit, patient is in cardiogenic shock, contraindications to thrombolysis

Question 3

What are the absolute contraindications to thrombolysis?

Answer 3

History of haemorrhagic stroke
Ischaemic stroke within 6 months
Major surgery, head injury, trauma within 3 weeks
GI surgery within 1 month
Aortic dissection
Bleeding disorder

Question 4

Which of the drugs for PE management that paramedics can use (under section 17) is NOT used

Answer 4

Streptokinase - practicalities of giving a controlled rate fusion, increased incidence of allergy and hypotension

Question 5

Which thrombolytic drugs can be given by paramedics and to which patients

Answer 5

Receteplase bolus of 10 units in 10ml of water for STEMI patients within 12 hours of symptom onset
Tenecteplase bolus of 10,000 units in 10ml of water for STEMI patients within 6 hours of symptom onset

Question 6

Why is intraarrest thrombolysis probably not practical?

Answer 6

Can’t diagnose STEMI during an arrest, bleeding risk during compressions, low perfusion pressure with CPR means drugs don’t get around

Question 7

In trials, no antiplatelet or LMWH was giving alongside thrombolysis, how would this affect the success rates?

Answer 7

Thrombolysis increases platelet activation leading to releases of VWF, cytokines and plasminogen activator inhibitor which all lead to inhibitor of thrombolysis therefore without antiplatelet thrombolysis is less effective

Question 8

When would you use prehospital fibrinolysis over in-hospital fibrinolysis (ERC guidelines)

Answer 8

Transport to hospital is >30 minutes

Question 9

If a patient with a STEMI arrives at a non pci hospital, what is done?

Answer 9

If the patient (symptom onset between 3-12 hours) can still reach a pci hospital within the 2 hour window then transfer them
If not, give fibrinolysis and then transfer for angiography 3-24 hours after

Question 10

In which circumstances would you pci someone less than 3 hours post fibrinolysis

Answer 10

If fibrinolysis fails