James calculated: Door-to-needle time would be 82 minutes if they gave alteplase now. But giving thrombolysis before transfer to thrombectomy carries bleeding risk if the clot doesn’t move.
James ran through the ROSIER score: 5 out of 10 – high probability of acute stroke. Crucially, the wife confirmed symptom onset exactly 52 minutes ago. That put Mr. Patel within the 4.5-hour window for thrombolysis, but only if the CT head was clear of haemorrhage and the team moved fast. The stroke team was paged. But the radiology department had just called a “red alarm” – the sole CT scanner was occupied by a major trauma patient with a possible pelvic fracture, and the next slot was 20 minutes away. James faced a decision: wait for CT or consider transfer to a neighbouring hyperacute stroke unit 12 miles away. emergency medicine journal
“Status epilepticus? Or stroke progression?” James murmured. He gave 2 mg IV lorazepam. The jerking stopped, but the aphasia and hemiparesis remained unchanged. James calculated: Door-to-needle time would be 82 minutes
Author: Dr. A. Rivers, Emergency Department, City General Hospital Crucially, the wife confirmed symptom onset exactly 52