Emergency Medicine Journal __top__ -

The stroke consultant, Dr. Khan, arrived. “This is a large vessel occlusion. Thrombolysis alone may not recanalise. We need mechanical thrombectomy, but our nearest centre is 45 minutes away by ambulance.”

Emergency Medicine Journal – Narrative Case Series Presentation It was a Tuesday afternoon in a busy UK district general hospital. The department was in its usual post-lunch chaos when triage flagged a 58-year-old man, Mr. Patel, as “priority 2 – possible stroke.” The paramedic handover was clipped: “Found by his wife at home, last known well 45 minutes ago. Sudden right-sided weakness, slurred speech, and facial droop. GCS 14. BP 185/100, HR 88, SpO₂ 97% on air. Blood glucose 6.2 mmol/L.” emergency medicine journal

Author: Dr. A. Rivers, Emergency Department, City General Hospital The stroke consultant, Dr

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. Thrombolysis alone may not recanalise

“Status epilepticus? Or stroke progression?” James murmured. He gave 2 mg IV lorazepam. The jerking stopped, but the aphasia and hemiparesis remained unchanged.

Meanwhile, the nurse recorded a blood pressure of 205/110. James recalled the 2024 EMJ guidelines: BP >185/110 is a relative contraindication to IV alteplase unless rapidly controlled. He ordered IV labetalol 10 mg push. As the labetalol took effect (BP 168/94), Mr. Patel suddenly became agitated. His left arm began jerking rhythmically. The monitor showed tachycardia to 120. Junior doctor Sarah shouted, “Seizure?” James shook his head – the movements were focal, but the patient’s eyes were deviated to the left, and he was unresponsive.