Good luck making that 3 hour window....

[txterp98]

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http://www.msnbc.msn.com/id/16813344/

What do you guys think of this? I don't know about where you guys practice, but unfortunately our MRI machine isn't adjacent to our CT machine! And our time delay between the two modalities NO WAY is only "15 to 20 minutes" when you figure in all of the logistics!

 

[DropkickMurphy]

http://www.msnbc.msn.com/id/16813344/

What do you guys think of this? I don't know about where you guys practice, but unfortunately our MRI machine isn't adjacent to our CT machine! And our time delay between the two modalities NO WAY is only "15 to 20 minutes" when you figure in all of the logistics!

However, others argue it's not such a clear-cut choice. MRI results take more time, a delay that can prove deadly to a stroke patient, these doctors contend.

"The time delay between MRI and CT may be around 15 to 20 minutes," said Dr. Joseph Broderick, chairman of neurology at the University of Cincinnati College of Medicine. "And in an emergency, 15 to 20 minutes can make a big difference."

I think he was referring to the difference in time it takes to do each study.....

 

[beyond all hope]

We do a CT to rule out other causes of neuro deficit in acute CVA, usually a bleed. The diagnosis is mostly clinical in the acute phase. The strokes that we 'lyse are mostly the classic huge MCA strokes which are easy to detect clinically. The more subtle strokes have too small a deficit to risk ICH that is always a concern with lytics.

Sure, we're not going to be finding those vertebrobasilar or lacunar strokes reliably on our exam, but we don't lyse most of them anyway.

Sure, MRI should be done to diagnose stroke. It's a better modality. However, the strokes we lyse you don't need an MRI beforehand. You need an MD.

 

[deleted109597]

What I got from that article (not having read the study, as I don't get the Lancet delivered to the house).
CT=AM radio.

Anyway, I do agree with them that stroke centers are better at treating patients, and this specialized hospital idea is not going to lose any ground.
I can see it now, every floor is a different "hospital"
1st Floor=ED, cafeteria
2nd Floor=Children's Hospital
3rd Floor=Heart Hospital
4th Floor=Stroke Center
5th Floor=Ortho Hospital
6th Floor=Spine Center
7th Floor=Women's Hospital
8th Floor=CEO's offices

 

[southerndoc]

I can see it now, every floor is a different "hospital"
1st Floor=ED, cafeteria
2nd Floor=Children's Hospital
3rd Floor=Heart Hospital
4th Floor=Stroke Center
5th Floor=Ortho Hospital
6th Floor=Spine Center
7th Floor=Women's Hospital
8th Floor=CEO's offices

Basement=Sewage and Resident Call Rooms

 

[DropkickMurphy]

9th Floor (w/ roof access)- Psych unit

 

[BADMD]

http://www.msnbc.msn.com/id/16813344/

What do you guys think of this? I don't know about where you guys practice, but unfortunately our MRI machine isn't adjacent to our CT machine! And our time delay between the two modalities NO WAY is only "15 to 20 minutes" when you figure in all of the logistics!

Stroke remains a clinical diagnosis. You use the CT to rule out a bleed before pushing lytics. Frankly, MRI is far less sensative for bleeding, so you would have have to do both before you could give TPA.

Basically, if a person has a consistant measurable deficit without evidence of bleed or exclusion criteria and are in the window, you give TPA. I actually gave lytics 2 months ago to a lady who was ultimately diagnosed as having a conversion disorder. She had consistant symptoms and stroke scale ~12. You can't get a comprehensive psych eval on everyone too.

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By way of intro, since I haven't posted before, I'm an EM PGY-3 who has made the questionable decision to go into toxicology in July.

 

[Jeff698]

The article said MRI detected more strokes than CT. It didn't say what the gold standard was. Not that I'm interested enough to look it up, of course.

Also, there was this helpful bit of information:

"The first few hours following a stroke are critical, since clot-busting drugs must be given within three hours to have a real impact. If they are given to the wrong patients, however, death or severe disability can result."

Good thing death or severe disability never happens when given to the right patients, huh?

Take care,
Jeff