The use of thrombolytic therapy in patients presenting to a peripheral metropolitan emergency department with acute myocardial infarction.
BACKGROUND
While use of thrombolytic therapy in the management of acute myocardial infarction has become accepted practice in major teaching hospitals, its use in peripheral metropolitan hospitals has not been well accepted.


OBJECTIVE
To evaluate the use of thrombolytic therapy in the management of acute myocardial infarction in the Emergency Department (ED) of a peripheral metropolitan hospital.


METHODS
A mixed prospective and retrospective observational study of 69 patients with acute myocardial infarction, who received thrombolytic therapy during a three year period, was conducted in a community based ED.


RESULTS
Demographic data, door to drug interval, complications occurring during administration of thrombolytics and subsequent interhospital transfer were recorded. The mean door to drug interval in 1992 was 79.7 minutes (95% CI: 50.7 to 109.1) and by 1994 this had fallen to 25.6 minutes (95% CI: 18.9 to 32.3). Hypertension (22%) was the most common complication of therapy observed and cardiac arrest occurred in two cases (3.2%). A single episode of hypotension and vomiting were the only complications that occurred during interhospital transfer. There were no deaths during therapy or transfer.


CONCLUSIONS
Thrombolytic therapy can be undertaken in the EDs of peripheral metropolitan hospitals in a safe and timely manner. There is little justification for routine medical escorts in the clinically stable post thrombolysis patient.
Jacobs
I G
IG
School of Public Health, Curtin University of Technology, Perth, Western Australia.
Fatovich
D M
DM
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017723:Drug Utilization Review; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006786:Hospitals, Urban; D006801:Humans; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy*; D016134:Organizational Policy; D010360:Patient Transfer; D012189:Retrospective Studies; D013300:Streptokinase / Q000627:therapeutic use; D015912:Thrombolytic Therapy / Q000009:adverse effects / Q000706:statistics & numerical data*; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use; D014904:Western Australia
D005343:Fibrinolytic Agents; D013300:Streptokinase; D010959:Tissue Plasminogen Activator