To anyone who might know….
In the ER a patient is diagnosed with an acute MI. Streptokinase is
begun via a peripheral IV being kept open with normal saline at a keep
vein open rate, 40 cc an hour. The strepto was prepared in 100cc normal
saline and placed on a pump to infuse in 45 minutes. After the strepto
is infused, the nurse notices the IV site is infiltrated to the extent
there is a large edematous area distal to the IV site. She checked the
IV 20 min into the transfusion and thought it was okay, but now is not
sure. Bottom line is, nobody knows how much strepto the pt received.
He’s still complaining of excruciating chest pain (in spite of a
nitroglycerin drip) and his ST segment shows no change. Furthermore, at
this particular facility, there is no angioplasty. NOW how do you plan
to treat the patient, given he may or may not have received some or any
thrombolytic?
If anyone has any ideas, I would be very interested in hearing what they
are.
Thanks,
Christopher Binder, RN
To: RCKY…@PRODIGY.COM
R>From: RCKY…@prodigy.com (Christopher Binder)
R>
R>To anyone who might know….
R>
R>In the ER a patient is diagnosed with an acute MI. Streptokinase is
R>begun via a peripheral IV being kept open with normal saline at a keep
R>vein open rate, 40 cc an hour. The strepto was prepared in 100cc
R>normal saline and placed on a pump to infuse in 45 minutes. After the
R>strepto is infused, the nurse notices the IV site is infiltrated to
R>the extent there is a large edematous area distal to the IV site. She
R>checked the IV 20 min into the transfusion and thought it was okay,
R>but now is not sure. Bottom line is, nobody knows how much strepto
R>the pt received. He’s still complaining of excruciating chest pain (in
R>spite of a nitroglycerin drip) and his ST segment shows no change.
R>Furthermore, at this particular facility, there is no angioplasty.
R>NOW how do you plan to treat the patient, given he may or may not have
R>received some or any thrombolytic?
R>
R>If anyone has any ideas, I would be very interested in hearing what
R>they are.
R>
R>Thanks,
R>Christopher Binder, RN
R>
R>
What a mess! I’d check the bleeding time first and Stat and then wonder
why it wasn’t given via coronary cath. -Rod-
Rod & Susan Venger, Venger’s Orchids
Homepage address http://www.usa.net/venger/
Listings Available – Email us for your copies
Order Line 1-800-483-6437
–
On 18 Jul 1996 13:56:24 GMT, RCKY…@prodigy.com (Christopher Binder)
wrote:
>this particular facility, there is no angioplasty. NOW how do you plan
>to treat the patient, given he may or may not have received some or any
>thrombolytic?
I would treat this as a failure of thrombolytics — I would be
extremely hesitant to administer another dose (or a partial dose) due
to the inability to know how much the patient received with the
initial dose.
Bottom line: the patient needs to be transferred to a facility which
has an interventional lab.
____________________________________________________________
Chris Klugewicz
Fellow, Div. of Cardiology
University of Maryland email: c…@chesbay.com
____________________________________________________________
Venger’s Orchids <ven…@earth.usa.net> wrote in article
<4spmsb$…@earth.usa.net>…
| To: RCKY…@PRODIGY.COM
|
| R>From: RCKY…@prodigy.com (Christopher Binder)
| R>
| R>To anyone who might know….
| R>
| R>In the ER a patient is diagnosed with an acute MI. Streptokinase is
| R>begun via a peripheral IV being kept open with normal saline at a keep
| R>vein open rate, 40 cc an hour. The strepto was prepared in 100cc
| R>normal saline and placed on a pump to infuse in 45 minutes. After the
| R>strepto is infused, the nurse notices the IV site is infiltrated to
| R>the extent there is a large edematous area distal to the IV site. She
| R>checked the IV 20 min into the transfusion and thought it was okay,
| R>but now is not sure. Bottom line is, nobody knows how much strepto
| R>the pt received. He’s still complaining of excruciating chest pain (in
| R>spite of a nitroglycerin drip) and his ST segment shows no change.
| R>Furthermore, at this particular facility, there is no angioplasty.
| R>NOW how do you plan to treat the patient, given he may or may not have
| R>received some or any thrombolytic?
| R>
| R>If anyone has any ideas, I would be very interested in hearing what
| R>they are.
| R>
| R>Thanks,
| R>Christopher Binder, RN
| R>
| R>
|
Interesting situation.
I would consider the risk of continuing with thrombolysis and depending on
the patient’s age and medical condition as well as the size of his
myocardium at risk, I would consider tPA. Reasoning is tPA is much shorter
acting than streptokinase and it will act faster. This way I do not have to
waste time checking any labs stat and I will give the patient a chance for
revascularizing and minimizing his myocardial damage.
On the other hand this may increase his chances of bleeding complications,
that’s where the patient’s general condition comes in.
I could be wrong but these are my thoughts.I’m interested in other views,
please post.
Osama Al-Bawab, M.D.
In article <4slfq8$1…@useneta1.news.prodigy.com>,
RCKY…@prodigy.com (Christopher Binder) wrote:
- Hide quoted text — Show quoted text -
>To anyone who might know….
>In the ER a patient is diagnosed with an acute MI. Streptokinase is
>begun via a peripheral IV being kept open with normal saline at a keep
>vein open rate, 40 cc an hour. The strepto was prepared in 100cc normal
>saline and placed on a pump to infuse in 45 minutes. After the strepto
>is infused, the nurse notices the IV site is infiltrated to the extent
>there is a large edematous area distal to the IV site. She checked the
>IV 20 min into the transfusion and thought it was okay, but now is not
>sure. Bottom line is, nobody knows how much strepto the pt received.
>He’s still complaining of excruciating chest pain (in spite of a
>nitroglycerin drip) and his ST segment shows no change. Furthermore, at
>this particular facility, there is no angioplasty. NOW how do you plan
>to treat the patient, given he may or may not have received some or any
>thrombolytic?
>If anyone has any ideas, I would be very interested in hearing what they
>are.
>Thanks,
>Christopher Binder, RN
Check the fibrinogen level STAT…AND transfer to another facility assuming
that it is a failure of SK therapy. By the time the transfer is made, the
fibrinogen results should be available, and the center with a cath lab can
make their own decision as to how to treat. But I would not waste more time
by sitting, waiting and "wondering".
Gregg Gaylord MD
P.S. Would maintain an IV heparin drip…..while doing the previously
suggested transfer AND fibrinogen level…..:)
Gregg Gaylord
- Hide quoted text — Show quoted text -