Sunday, April 20, 2008

For "Dedicated Dad"

I've been doing this a long time. And I humbly say if any ED doc or neurologist gave me or any of my family or friends thrombolytics for a stroke like symptoms, I WOULD SUE THEM!
Does that make it easier for you?
There is NO predictive test or scale that says when it is appropriate to do so! Fuckin period over and out!
My past institution was involved in the initial research for this treatment and after 3 of the first eight died and 4 of the others converted to hemorrhagic stroke and worse outcome, we respectfully withdrew from the study and never gave the drugs again. And this is a group practice/training institution/medical school institution that is in the top 10 largest in the nation.
There is NO convincing evidence that this therapy helps and in many, if not most, cases makes it worse, given the fact that we have NO WAY of predicting how a "stroke presentation" will turn out. They are just as likely to walk out of the hospital as go to a nursing home with the same initial presentation.
I have personally cared for many patients who presented with a complete hemiparesis, who recovered COMPLETELY with nothing but OBSERVATIION..
God, I want to say more to/at you but will refrain given the stated fact your loved one had a less than 100% recovery, and I am sorry for that, but it had NOTHING to do with the individual treatment or percieved lack there of..
I'm too old for you people to get me this stirred up!!!


  1. We had one guy who came in with classic stroke symptoms, relatively high on the NIH stroke scale as administered by our vaunted stroke team.

    Then he sneezed. All better.

    Unfortunately, wasn't there just a study in Annals studying case law, that EM docs were more likely to get sued for not giving tPA in stroke situations than for giving it, regardless of outcome?

    Litigation Based Medicine (LBM).

  2. Amen Fart! I dispise this whole "Brain Attack" approach to strokes. I am convinced that it's all for marketing.

    In my experience, I've witnessed just as many (if not more) spontaneous recoveries than I have successful tPA conversions. I have seen several patients die because of the tPA.

    The lay person just doesn't get how the NINDS data are manipulated. They think medical literature is about patient care and medical advances...not realizing that much of the medical literature is geared toward selling expensive treatment modalities.

    You're correct tyro, we do stand a risk of being sued for not using it. Still, I'd rather follow the "First Do No Harm" rule and take the consequences.

  3. careful oldfart... the ticker might start acting up again!

  4. My Mom once said, "Let me take care of them, they will die, but it doesn't have to be now.
    She died in OR getting prep'd for an internal fibulator.
    As an ICU head Nurse she knew the risks with the surgery and asked my opinion. Yea I also have reservations.
    I'm just glad she never had to worry about lawsuits.
    Yes she used to complain about Admin. and their bottom line vs care.
    Good luck!

  5. I found this a couple of days ago, I have let it sit, and read it a few more times before responding.

    I also re-read my original post each time as well, trying to figure out how what I wrote provoked this response.

    I asked for input here because this place is -- of all the "med-blogs" I read -- the one that I seem to find most filled with decent people. The post to which I commented reminded me of his situation, and I thought I might be able to learn something.

    I must say that I'm not too sure how to take the last paragraph+ and thus the whole post.

    I didn't -- WE (the family) haven't -- taken any action at all, short of attempting to figure out what went wrong. I was seeking input toward that end, and still don't know what I said to bring on such a reaction.

    I guess I also should have been more clear about some other things.

    My Dad is a stereotypical "Southern Gentleman" and a universally well-liked local figure. He's been a Pastor most of his life, and truly exemplifies the standards of his faith as regards his behavior in public and most especially his treatment of others.

    He's meek and soft-spoken, kind and understanding to a fault. Neither he nor any of the rest of his family would dream of being the sort of demanding, self-centered @$$-hats whose descriptions frequently grace this and other ER-blog pages.

    When I say he lay in the ER bed for 7+ hours, that's literally what happened. A physician spent a couple of minutes with him soon after his arrival and did a very basic neuro-exam.

    An IV was established and a saline drip was set so slowly that the bag still hadn't emptied when he was finally admitted ~6+ hours later.

    I understand this was to enable quick infusion of meds if necessary -- a basic precaution -- and thus didn't really qualify as "treatment."

    Otherwise, even the nurses didn't enter the curtains again except for a couple of occasions when his wife -- who was sitting there watching him continue to deteriorate -- politely requested that someone come check on him.

    I'm no Doctor or Nurse, although in my younger days was a volunteer EMT and I am quite a bit more self-educated than most people.

    For these reasons it would take an awful lot for me to judge treatment to be improper.

    That said, in this case his treatment was pretty much nonexistent.

    At the end of the hours of wait, when a neurologist finally appeared, he himself seemed more than a little upset about the utter lack of prior care. Upon learning that Dad had continued to steadily deteriorate for hours, he asked specifically if the staff was aware, and if they'd said anything to Dad and/or his wife.

    It would seem to me that under the circumstances a CAT scan would have been appropriate, but I would very much appreciate being educated if I am wrong.

    Is the standard of treatment for an obvious stroke "wait and see"? Is that really all we have?

    I want to understand, and would appreciate any assistance you may be willing to offer toward that end.



  6. sorry you got flamed. i did not flame you as you can see. let's be clear, if he did not get a CT scan of the brain immediately then all that is said above is bunk. that's flat out malpractice. without even seeing him i would have sent him strait to the scanner. this delay COULD have been significat. please speak with the treating neurologist to better understand if THEY think things were botched.
    God Bless