"I had a very similar patient a few months ago.
Completely aphasic, right sided paresis, new onset afib.
Had a bag of normal saline running while I was waiting for TPA.
All of his symptoms resolved.
If the pharmacy was faster, I would have said that the TPA treatment was a miracle."
I believe what you saw there is a common occurence. Where I work, we have trouble getting tPA down to the ED from the pharmacy in a timely manner. Therefore, we see a lot of severe strokes resolve or improve BEFORE the tPA is given. However, at a major, busy stroke center where tPA is given often and fast, I believe there is probably an inherent bias in believing that the tPA was magically fixing strokes as opposed to pts resolving a TIA.
For pts that receive tPA at our hospital, upon discharge, we report an arrival NIH score, a discharge NIH score, & modified Rankin score and of course, patients mostly go home in better condition. I feel that there is a tendency for a lot of the medical and non-medical hospital employees to think that the discharge improvements are mostly due to tPA administration as opposed to the PT/OT, & natural course of disease. They never report the same numbers for those that do not receive tPA but I suspect that they would all demonstrate some improvement as well upon discharge.
I don't really know where I stand on the tPA "debate," but I do have a problem with the myth that it's some miracle drug that just needs to be given at the right time. I think the myth has been perpetuated by the implementation of these guidelines and rampant certification of stroke centers. I have noticed this type of bias especially among nurses and techs that worked at busy stroke centers where tPA can be given within 30 minutes of arrival. They are amazed when I tell them that there are doctors (both EM and neurology) that are not sold on tPA and for many, the guidelines are upsetting and controversial. They always tell me, "But I've seen it work before my eyes!"
Completely aphasic, right sided paresis, new onset afib.
Had a bag of normal saline running while I was waiting for TPA.
All of his symptoms resolved.
If the pharmacy was faster, I would have said that the TPA treatment was a miracle."
I believe what you saw there is a common occurence. Where I work, we have trouble getting tPA down to the ED from the pharmacy in a timely manner. Therefore, we see a lot of severe strokes resolve or improve BEFORE the tPA is given. However, at a major, busy stroke center where tPA is given often and fast, I believe there is probably an inherent bias in believing that the tPA was magically fixing strokes as opposed to pts resolving a TIA.
For pts that receive tPA at our hospital, upon discharge, we report an arrival NIH score, a discharge NIH score, & modified Rankin score and of course, patients mostly go home in better condition. I feel that there is a tendency for a lot of the medical and non-medical hospital employees to think that the discharge improvements are mostly due to tPA administration as opposed to the PT/OT, & natural course of disease. They never report the same numbers for those that do not receive tPA but I suspect that they would all demonstrate some improvement as well upon discharge.
I don't really know where I stand on the tPA "debate," but I do have a problem with the myth that it's some miracle drug that just needs to be given at the right time. I think the myth has been perpetuated by the implementation of these guidelines and rampant certification of stroke centers. I have noticed this type of bias especially among nurses and techs that worked at busy stroke centers where tPA can be given within 30 minutes of arrival. They are amazed when I tell them that there are doctors (both EM and neurology) that are not sold on tPA and for many, the guidelines are upsetting and controversial. They always tell me, "But I've seen it work before my eyes!"
