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Chapter 4

Lit Matters 2: TPA for Stroke Mimics

Matt Delaney, MD and Salim Rezaie, MD
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What happens to stroke mimics that get TPA?

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Robert P. -

This study is absolutely being weaponized against ER docs and patients. We switched to a telestroke model recently and they want to give TPA to everyone. “I don’t think she’s having a stroke, but TPA is safe is stroke mimic so there’s no reason not to give it.” The telestroke doc is usually online before the patient arrives if they are coming via EMS and once that train is rolling you can’t stop it, even for obvious non-stroke like a pre-hospital glucose of 20.

Just one more medical decision being taken out of our hands. Keep admin happy, don’t think, just click the boxes and meet the goals, don’t worry about whether it’s good for your patient or not.

Rob O., MD -

Ack! Sorry to hear that and I feel your pain. It sometimes feels like equal degrees of energy expenditure convincing patients they don't need a z-pack for their URI and telestroke that lytics might not be the best move. I'm not sure your experience, but I never once got a note from admin admonishing me for giving lytics when they were questionable but plenty for not giving them when I thought they were a bad idea but popped up on their radar as a missed metric.

All that being said, most of the telestroke neurologists have been pretty reasonable people. They are in the dubious position of being a hammer so everything looks like a nail. When discussing the clinical nuance as to why lytics right away shouldn't happen, I found most responsive to discussion. The problems I had were when I essentially surrendered care and went on to see other patients and then saw the lytics being brought into the room. My heart would sink and I'd ask the neurologist why the lytics but by then it was too late.

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2.25 AMA PRA Category 1 Credits™ certified by Hippo Education (2020)