Document Detail

Detecting failed thrombolysis in the accident and emergency department.
MedLine Citation:
PMID:  14521968     Owner:  NLM     Status:  MEDLINE    
The primary objective in managing a patient with ST segment elevation myocardial infarction (STEMI) is to establish reperfusion in the infarct-related artery and to maintain it. Two approaches to coronary reperfusion are used in the UK - primary angioplasty and intravenous thrombolysis. Primary angioplasty is the gold standard approach to managing STEMI, but in the UK (due to financial, resource and personnel limitations) this is not the first-line treatment. Thrombolytic therapy remains the most widely used approach and the benefits of such an approach are irrefutable; thrombolysis saves lives, reduces infarct size and limits left ventricular dysfunction. However, data from the thrombolytic trials also suggest that 30-40% of patients fail to reperfuse with standard thrombolytic therapy. Similar data demonstrates that patients who do not sustain adequate perfusion in the infarct-related artery have a poor prognosis and increased mortality rates. As long as thrombolysis remains the standard therapy for STEMI, it is important that patients in whom the treatment has been unsuccessful are swiftly recognised and appropriate interventions instituted. The criteria to assess successful reperfusion of the infarct-related artery need to be simple to apply, easy to interpret and non-invasive. This article will discuss the most useful criteria to make such a diagnosis and suggest approaches to enable recognition of 'failed thrombolysis' in the accident and emergency department. The current views on managing failed thrombolysis will conclude the article.
Christine M Spiers
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Accident and emergency nursing     Volume:  11     ISSN:  0965-2302     ISO Abbreviation:  Accid Emerg Nurs     Publication Date:  2003 Oct 
Date Detail:
Created Date:  2003-10-02     Completed Date:  2003-12-17     Revised Date:  2005-11-16    
Medline Journal Info:
Nlm Unique ID:  9305090     Medline TA:  Accid Emerg Nurs     Country:  Scotland    
Other Details:
Languages:  eng     Pagination:  221-5     Citation Subset:  N    
Faculty of Health, Institute of Nursing and Midwifery, University of Brighton, Westlain House, Village Way, Falmer, BN1 9PH, Brighton, UK.
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MeSH Terms
Biological Markers / blood
Drug Monitoring / methods,  nursing
Emergency Nursing / methods
Emergency Treatment / methods*,  nursing
Great Britain
Myocardial Infarction / diagnosis,  drug therapy*,  metabolism
Nurse's Role
Patient Selection
Thrombolytic Therapy* / methods,  nursing,  standards
Treatment Failure
Reg. No./Substance:
0/Biological Markers

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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