There are several services that carry thrombolytics, Retavase is the usual choice. A good idea in theory, but many have realized that 'lytics are a temporary solution to a permanent problem. These folks need a cath lab instead. If one isn't available for an extended period of time, then I could see giving it. But if there is access to a cath lab within an hour or two, then administering 'lytics is actually counterproductive. There's been a couple of threads about these, they may have some more insight...............................
Our system uses them. We are quite a ways out and have no Cath Lab available locally. They are given both in the field and in the ER.
A friend got it in the ER here, and then was ALS transported to the closest hospital for follow up. By the time he got there, the EKG strip puzzled the admitting nurse. She couldn't understand why a guy with a normal EKG was being brought into her facilty in an ALS ambulance. Wasn't until she saw the initial strip that she started paying attention!
Its a pricey treatment though and has a list of contraindications a mile and a half long.
Actually, thrombolytics have been on the decreased with the promotion of more door to cath.. even the time limit has been increased as research has demonstrated that catheterization is more favorable if possible.
Thrombolytics are also something that has recycled itself in the field as did cath labs. The 1980s brought us "Cath-in-a-Can" with many portable cath labs being set up but were often several miles from an OR that could do open chest quickly. The 80s also brought thrombolytics to Paramedics in the field. However, this was introduced to EMS providers in urban areas that had Cath Labs at nearby hospitals.
