The TPA Time Limit For Acute Stroke Causes Mass Chaos In The ER
Posted Sep 01 2010 7:25pm
I hate acute strokes. There are several reasons for it. Most of them are logistical. First, everyone gets into a tizzy because of the 3 (or 4.5) hour time limit after the onset of symptoms that which TPA can be given and hopefully improve the patient’s outcome. Unfortunately, this time limit (and the data for TPA’s efficacy is only OK at best) causes mass chaos and annoyance.
First, one has to establish 100% what the exact time of onset was. This is not easy most of the time. I would say about 80% of “acute” strokes brought in by EMS turn out to not be within that window. It takes more than just saying “when did the symptoms start?”
Often the patient is elderly and demented. Often they live alone. Often there were milder symptoms before that were ignored or unrealized. Occasionally the person has hemi-neglect and can’t really say when things started. Sometimes there is alcohol on board. Sometimes the symptoms are on top of pre-existing stroke damage and it is hard to tell if it is really new or worse. Sometimes patients probably had a seizure at onset and that prevents them from getting TPA.