The time from door to order and door to final report (for CT scan) misses a huge component. When the order is placed, The order has to be received by the radiology technician in the CT scanner, the patient has to be transported to the CT scanner, patient information his to be placed in the radiology information system(RIS). Patient has to be placed in the scanner, images have to be acquired and sent to the PACS (radiology images are a separate system from RIS) system in their entirety (can be 200 images for non contrast head CT up to 3000 for a ct angiogram of head. The images are then interpreted by radiologist. So when goal is 45 min door to CT read, it assumes a lot of things that radiologist has no control over. Their clock should not start until the images are fully acquired and sent to PACS.
He had an MRI result with 2.5 hours of arrival at the ED?! This is really impressively quick even for a large stroke center. These plaintiff experts must be high when they review these cases; they are clearly divorced from reality. This was a case of bad luck for the patient and not bad medical care. They got good care and those doctors were punished despite that.
Can you list the states in which these cases are occurring in? I think it's important to be transparent to medical trainees that the abuse of local malpractice laws by nefarious family members and lawyers are more prominent in certain states. Well informed physicians should do themselves a favor and not choose these states to ever practice in.
Good case, lots of delays to care here. It appears this was at a stroke center which makes some of the clinical decisions suspect, no CTA?, no thrombectomy or transfer?
The real reason I'm here is your statement "The utility of tPA in strokes has been called into question recently, with analysis of multiple studies showing that there is probably no benefit, if not harm". Are we still doing this? Even the ACEP agrees at this point in the right structure (ie stroke centers) tPA is beneficial. I have read the point and counterpoint to the data of the early trials and there is risk but clear benefit. The newest data (EXTEND) also shows the early benefit at 24 hours that NINDS and ECASSII lacked but also confirms long term improvement. I think we can put this to bed. tPA works, but comes with risk, in a structure with docs in ED and neurology who examine and determine candidacy quickly and deliver medicine fast the benefits outweigh the risks.
The time from door to order and door to final report (for CT scan) misses a huge component. When the order is placed, The order has to be received by the radiology technician in the CT scanner, the patient has to be transported to the CT scanner, patient information his to be placed in the radiology information system(RIS). Patient has to be placed in the scanner, images have to be acquired and sent to the PACS (radiology images are a separate system from RIS) system in their entirety (can be 200 images for non contrast head CT up to 3000 for a ct angiogram of head. The images are then interpreted by radiologist. So when goal is 45 min door to CT read, it assumes a lot of things that radiologist has no control over. Their clock should not start until the images are fully acquired and sent to PACS.
He had an MRI result with 2.5 hours of arrival at the ED?! This is really impressively quick even for a large stroke center. These plaintiff experts must be high when they review these cases; they are clearly divorced from reality. This was a case of bad luck for the patient and not bad medical care. They got good care and those doctors were punished despite that.
Can you list the states in which these cases are occurring in? I think it's important to be transparent to medical trainees that the abuse of local malpractice laws by nefarious family members and lawyers are more prominent in certain states. Well informed physicians should do themselves a favor and not choose these states to ever practice in.
Unresponsive? Describe further. Isolated MCA stroke would not be expected to cause severe alteration in LOC
Good case, lots of delays to care here. It appears this was at a stroke center which makes some of the clinical decisions suspect, no CTA?, no thrombectomy or transfer?
The real reason I'm here is your statement "The utility of tPA in strokes has been called into question recently, with analysis of multiple studies showing that there is probably no benefit, if not harm". Are we still doing this? Even the ACEP agrees at this point in the right structure (ie stroke centers) tPA is beneficial. I have read the point and counterpoint to the data of the early trials and there is risk but clear benefit. The newest data (EXTEND) also shows the early benefit at 24 hours that NINDS and ECASSII lacked but also confirms long term improvement. I think we can put this to bed. tPA works, but comes with risk, in a structure with docs in ED and neurology who examine and determine candidacy quickly and deliver medicine fast the benefits outweigh the risks.