NDLI: Thrombolysis in acute myocardial infarction: the safety and efficiency of treatment in the accident and emergency department.

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Thrombolysis in acute myocardial infarction: the safety and efficiency of treatment in the accident and emergency department.

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Thrombolysis in acute myocardial infarction: the safety and efficiency of treatment in the accident and emergency department.

Content Provider	PubMed Central
Author	Edhouse, J. A. Sakr, M. Wardrope, J. Morris, F. P.
Abstract	OBJECTIVES: To assess the safety and efficiency with which the accident and emergency (A&E) department provides thrombolytic treatment for patients with acute myocardial infarction (AMI). METHODS: A prospective observational study based in a teaching hospital for one year. All patients who presented with the clinical and electrocardiographic indications for thrombolytic treatment were studied. Patients were grouped according to route of admission. After logarithmic transformation, the "door to needle times" of the groups were compared using a two tailed Student's t test. Arrhythmias and complications after thrombolytic treatment were noted. The appropriateness of the treatment was assessed retrospectively by review of the clinical records and electrocardiograms, judged against locally agreed eligibility criteria. RESULTS: Data from 153 patients were analysed; 138/153 (90%) patients were admitted via the A&E department. The shortest door to needle times were seen in those patients thrombolysed by A&E staff within the A&E department (mean 43.8 minutes). The transfer of A&E patients to the coronary care unit (CCU) was associated with a significant increase in the door to needle time (mean 58.8 minutes, p = 0.004). Only one malignant arrhythmia occurred during the administration of thrombolysis in the A&E department, and this was managed effectively. No arrhythmias occurred during transfer of thrombolysed patients to the CCU. In every case, the decision to administer thrombolysis was retrospectively judged to have been appropriate. CONCLUSIONS: The A&E department provides appropriate, safe, and timely thrombolytic treatment for patients with AMI. Transferring A&E patients to the CCU before thrombolysis is associated with an unnecessary treatment delay.
Starting Page	325
File Format	PDF
ISSN	13510622
Journal	Journal of Accident & Emergency Medicine
Issue Number	5
Volume Number	16
Language	English
Publisher Date	1999-09-01
Access Restriction	Open
Subject Keyword	Research in Higher Education
Content Type	Text
Resource Type	Article
Subject	Medicine

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