[CARPA] Re: cardiac thrombolysis in remote areas.

[Christine.Connors at nt.gov.au]

Thrombolytics have been used in Top End remote health centres for a number of
years, with no significant problems. Most of these centres have nurses who
intitiate treatment based on ECG result and discussion with doctor. we have
changed from reteplase to tenecteplase

CA clinics were slower to start, and many didnt have defibrillators which caused
anxiety. However this has now been adopted

the risk of reperfusion arrhythmia's is much lower than the risk of arrhythmia's
due to ongoing ischemia

You will need an active education program for all staff (remote nurses, RFDS
doctors and nurses, hospital staff and remote management)  to introduce this
change as there are a lot of myths and misconceptions about thrombolytics.
Having evidence such as Scottish paper is helpful, as well as active support
from key cardiology people in your area.

we are seeing improved life expectancy for ATSI people and reduced CVS deaths in
NT, with similar patterns occurring interstate
given that CVD are the major cause of death and tyranny of distance, best
practice management is even more critical for people in remote areas

christine




Dr. Christine Connors
Program Director PCD
NT Department of Health & Community Services
Phone: (08) 8922 8218
Fax:      (08) 8922 7714
Mobile: 0401 116 121
email: christine.connors at nt.gov.au









                                                                                
             "Sabina Knight"                                                    
             <Sabina.Knight at flin                                                
             ders.edu.au>                                                    To 
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                                                                        Subject 
                                         [CARPA] Re: cardiac thrombolysis in    
             30/01/2007 01:55 PM         remote areas.                          
                                                                                
                                                                                
              Please respond to                                                 
             Central Australian                                                 
             Rural Practitioners                                                
                 Association                                                    
             <carpa at ozdocit.org>                                                
                                                                                
                                                                                




The CARPA guidelines 4th edition recommend Thrombolytcs once diagnosis is
confirmed. it is kept in remote clinics and given under remote advice and
support. There was some resistance earlier, generally it is now excepted that
time is muscle and that remote people who have high risk of cardiovascular
events should have access to safe high quality treatment that is evidence based.
To date there have not been any adverse events that I'm aware of. CARPA
guidelines are policy for all in the NT and the 3 states of Central Australia
and are are used in SA and north WA.

The REC program has been the mainstay for most RANs and provided training for
remote practitioners - not all have been able to access it.

Sabina

Sabina Knight
Senior Lecturer Remote Health Practice & CRANA Research Fellow
Centre for Remote Health
Ph 61 8 89514709
Mob 0417823933



>>> "EriK Van Den Berg" <erik_vandenberg at health.qld.gov.au> 19/01/2007 9:01 am
>>>


Just wondering if any of the remote areas are keeping and using Thrombolytics in
their clinics for administration by NURSES under the direction of a remote
doctor.

In the Cape York area a few of the clinics keep Tenecteplase but there is no
consistant policy as to who, when, how etc.

A quick read of info on the internet shows that paramedics are using
thrombolytics in remote areas of Scotland - where they may be a few hours away
by road from the nearest hospital.

Locally there is some resistance from some people regarding the ability of
remote nurses to manage reperfusion arrhythmia's.

Has any-one else been down this road and managed to get suitable guidelines and
protocols and training in place?

If so it would be great to hear about it.

Thanks

Erik
Erik van den Berg
Outreach Pharmacist
Cairns Base Hospital
PH 4050-6287
FAX 4050-6585




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