Many stroke patients miss out on clot-busting drugs. However, consider what is going through the minds of ER docs when deciding the use the drug:

I abhor TPA. I too am a Board Certified ER Doc. Now if a patient comes in having an acute stroke, I can be sued for giving TPA (“He didn’t explain the risks well enough”) I can be sued for delayed treatment with TPA (“We Don’t care if there were 75 patients in the ER, that’s Irrelevant”) and I can be sued for withholding TPA (especially since most insurance companies would prefer settling out of court when the outcome in question is a life changing stroke). I’ve never seen it work, I saw it kill the Fire Chief of my city (He bled to death in his brain, in front of his entire department). What really pisses me off about TPA for stroke is it makes us ER docs call Neurologists for EVERY mild Neuro symptom, so in case it turns out to be a stroke, we can make them share the blame and legal responsibility. (I find myself and my colleagues calling Neurology for patients with vertigo, “in case” it’s a cerebellar stroke) We never used to do this, and it adds to the clogging of our ER’s. All because that “clotbuster” is on our shelf.

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