and place a stent, then you have to do bypass surgery.
Using thrombolytics, there is some absolute
relative type of contraindications, but keep
in mind, before we move on here, if your patient
is already in a state of bleeding why would
you want to use a thrombolytic? That is just going
to exacerbate the issue. It might actually
kill your patient. Who are my patients? Hemorrhagic
strokes, non-hemorrhagic stroke past three
months, intracranial neoplasia, active internal
bleeding, aortic dissection, closed head or
facial trauma, once again for three months.
Now take a look at some of these. If the patient
is already at risk for severe bleeding, by
adding a thrombolytic, these are absolute
contraindications for then using a thrombolytic
now. This is absolute for any licensing exam.
In clinical practice, you might always
find that attending who might be extremely
confident in his or her ability to still give
a thrombolytic in such situations, but that
is not being asked here nor is it going to
be asked on your boards. Relative, severe
hypertension, proliferative diabetic retinopathy,
what does that mean to you? You are thinking
about the eye and when undergoes proliferation,
you want to be careful though because what
might you do? By thrombolytic, you might then
cause bleeding take place. Known bleeding
diathesis, for example von Willebrand disease,
prolonged CPR, allergic reactions, pregnancy,
blood pressure, ulcers be careful there,
please. Very careful actually, for example,
when you use a thrombolytic at some point
with that ulcer, there might be so much bleeding
that you might actually bring about perforations.
So please be careful when using such drugs.
Contraindication for thrombolytics, absolute
versus relative. Now, management continues.
All patients with AMI should undergo intensive