The use of thrombolytics by GPs in the management of suspected myocardial infarction is indicated if:
A. More than 12 hours have elapsed since the onset of pain
B. Clinical suspicion remains despite a normal ECG
C. Intramuscular opiates have been given
D. ‘The call to needle time’ will exceed 90 minutes
The Correct Answer is D
General practitioners (though not at present ambulance paramedics) may wish to start thrombolytic treatment outside hospital providing that they have facilities for managing arrhythmia and for resuscitation, including defibrillators (which may be provided by an attending ambulance); they can accurately diagnose acute myocardial infarction by using clinical and electrocardiographic criteria; and they believe that pre-hospital treatment in each case will result in an appreciable time saving, particularly if this is the only way of achieving a 90 minute “call to needle” time.
The call to needle time should ideally be no longer than 60 minutes, but 90 minutes is a reasonable target for those patients with a readily diagnosed acute myocardial infarction.