This happened recently in one of my private ER visits. When I asked my fellow to lyse a patient with STEMI who arrived within 20 minutes after the onset of chest pain to our CCU.
He was reluctant and surprised, seemed to suggest thrombolysis is a banished indication.
I asked him , is there any study that showed early , fast pre-hospital thrombolysis is as good as primary PCI ?
True sir. . but these studies clearly say it is useful only if its done prehospitally sir, not inside the hospital or coronary care units.
I told him to think CCU as an ambualnce ,consider the patient is in transit and lyse him.
He was amused , as it looked a comical concept and an unscientific uttering from a professor !
Still, he was courteous enough to follow my advice.The patient stabilised within 6 hours ST the ST resolute to near 100 % , No Lv dysfunction.Discharged in 48 hours.
Final message
I realised in a harsh way , modern day scientists driven by evidence would struggle to regain the lost common sense ! There is a real risk for irreversible damage to our faculty of wisdom !
http://www.nejm.org/doi/full/10.1056/NEJMoa1301092
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