The ambulance arrives at the spoke hospital at 10.40.
The 60min alteplase infusion only started at 10.20. The spoke stroke physician has to make the difficult decision based on an assessment of risks and benefits whether to:
- Stop the alteplase infusion before transfer
- Delay the transfer until infusion has been completed
- Identify a suitably trained nurse who could manage the infusion during transfer
In this case the stroke physician decides to stop the infusion because no nurse is available to accompany the patient and the delay to thrombectomy may be reduced by at least 30 minutes. Had the patient been treated with Tenecteplase which is given as a single bolus no infusion would have been required (link back to “What is thrombolysis?”._
Vera is transferred into the ambulance by the paramedics. No nurse or anaesthetist is required for this transfer.
The family or next of kin do not travel in the transfer ambulance. Vera’s daughter drives John, Vera’s husband, to the thrombectomy centre.
Estimated transfer time: 1 hour.
