Recently, an individual presented at 0300 to our remote NW BC hospital with severe chest pain and diaphoresis. ECG showed borderline ST elevation in the inferior leads, but worsening over the first 1/2 hour despite NTG, ASA, Bblocker, morphone, Plavix load and enoxaparin. POCUS showed inferior wall motion abnormalities, correlating with the inferior lead territory on ECG. Additionally, good views of the aortic root showed no evidence of dissection.
When his ST segments acutely worsened (see photo), it was clear he would need to be thrombolysed. We have tenecteplase, which for a rural centre, is the only way to go as you just reconstitute and push. Nothing to it.
What helped immensely was a call to RUDi made from our hospital iPad. Dr Furstenburg answered and together, we quickly went through the contraindication checklist and risk / benefits discussion with the patient and spouse, while the med was being mixed. The moment he agreed, we pushed it and Dr Furtstenburg requested to stay on to watch the 12-lead over the next 15-20 minutes. While he observed the screen, labs and other treatments continued. Within 10 minutes, he was pain free with the ST segments coming down to normal, at which time, he had some brief reperfusion rhythms for which further excellent advice was given (“do nothing”). He was redlisted for transfer to St Paul’s, leaving within 12 hours, painfree.
So kudos to RTVS for providing such a great service to support rural practitioners. This is one of a great many stories like it. A friend in need is a friend indeed.
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