A Guide to Using this Survival Guide

The Amazing Mr. X

It is Canada Day and you are working in the ER.  At 2200 hours the triage nurse reports that a Mr. X has appeared with his wife and that he is is very lethargic and confused. He is a 55 year old man. His wife states that he was acting very oddly when she returned home today. She says that he has become incoherent, mumbling and acting quite lethargic. She states he was fine yesterday and able to work at his job. He is a smoker and treated for hypertension with acebutolol 200 mg bid. Mr. X has been hospitalized in the past for a renal stone and for hernia repair. He works as a plant foreman and lives with his wife and teenage children. He has no history of vascular or neurological or psychiatric disorder. His family history is positive for heart disease and for diabetes.

Suspecting stroke but feeling less than perfect with your recall of the minutiae of neuroscience, you turn to the Survival Guide for assistance. You are wondering whether or not thrombolysis might be in order. 

First, you go to the Clinical Assistant and click the Forms, Scales, and Scores heading to help your recollection of the Folstein Mini-Mental exam. While there you also look up the Canadian Stroke Scale. Then you find the Evidence Based Clinical Note for Acute Cerebral Infarction and review the indications and contraindications for thrombolysis therapy. The MMSE is 18. the CNS is 6.5 because of right hemiparesis and dysphasia.

You start your physical exam and you know you need to do a though  neurological exam and wonder if there are any specific tests.

You send your stable patient off to get a CT scan while you watch the video on how to perform an LP - just in case! When Mr. X comes back you have a quick look at the CT scan before calling anyone. By using the skills you acquired by practicing on the CT reader you are able to see and describe the stoke that he just had.

To  thromobolyse or not to thrombolyse? Where to go and how to get there quickly? Your quick check of the evidence and guidelines linked to the Evidence Based Clinical Notes has prepared you to discuss matters with it  with Mr. X and his wife. You can tell her that the best evidence in medicine points to urgent transfer for thrombolytic therapy. She agrees to the transfer.

You consult the Resource Locator in the Survival Guide to find the closest regional stroke centre and the Critical Care Transport service's contact number. You decide that helicopter transport to the Hamilton General Hospital will be the best plan. Before you call you check the Survival Guide for any site specific protocols for consulting this hospital and make sure you have done all the tests you need and have acquired  adequate information. After 2 short phone calls a helicopter arrives  to transfer the patient and his CT scan to the Hamilton General.

Practical uses of technology to help you survive!