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- Mar 15, 2011
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Who does this at your institutions? Ed alone? Ed discuss with neuro? Call of admission and let hospitalist and neuro decide? I always thought this was an Ed made decision with the pt.
Case
61 y/o female with htn and dyslipidemia, brought in by daughter for acute expressive aphasia. No motor defecits. But cannot speak. Can form words in her head, can sluggishly move tongue, but no words will come out. I am called for admission. 2:40 min into window.
Take quick history. Recognize this is very healthy young woman with obvious clinical defecit with complete aphasia that she writes out has gotten worse since it started from sluggish words to complete inability to talk. Walk out of room and ask Ed doc why she hasn't been tpad. She says she spoke with on call neurologist, who over the phone says nih scale is low, don't tpa. Does not come in to see pt. my feelings are pt should be tpad, or atleast given the option. Ed agrees. Says in her last hospital she made that decision in Ed. We agree to present tpa option to pt despite neurologists recommendation. Pt writes what is alternative. I tell her um, aspirin, rehab and um, we see what happens. She actually writes out t-p-a. So we give it to her, admit her, consult a different neurologist who comes in about 30 min later and sees her. Agrees with decision.
I get an earful on the phone later that night from initial neurologist.
Pt monitored in ICU overnight, no bleeding, spends next day on floor, goes home on day 3 with no defecit.
So. At your place...how does the tpa process get handled for said pt?
Case
61 y/o female with htn and dyslipidemia, brought in by daughter for acute expressive aphasia. No motor defecits. But cannot speak. Can form words in her head, can sluggishly move tongue, but no words will come out. I am called for admission. 2:40 min into window.
Take quick history. Recognize this is very healthy young woman with obvious clinical defecit with complete aphasia that she writes out has gotten worse since it started from sluggish words to complete inability to talk. Walk out of room and ask Ed doc why she hasn't been tpad. She says she spoke with on call neurologist, who over the phone says nih scale is low, don't tpa. Does not come in to see pt. my feelings are pt should be tpad, or atleast given the option. Ed agrees. Says in her last hospital she made that decision in Ed. We agree to present tpa option to pt despite neurologists recommendation. Pt writes what is alternative. I tell her um, aspirin, rehab and um, we see what happens. She actually writes out t-p-a. So we give it to her, admit her, consult a different neurologist who comes in about 30 min later and sees her. Agrees with decision.
I get an earful on the phone later that night from initial neurologist.
Pt monitored in ICU overnight, no bleeding, spends next day on floor, goes home on day 3 with no defecit.
So. At your place...how does the tpa process get handled for said pt?