Transcription - 20260106T 09-44.mp3

Christine rhodes update on discussions overnight discussed with 2 sons and son-in-law at the bedside bedside regarding findings on ct head which have demonstrated large vessel occlusion and a significant stroke explained that unfortunately this is a large stroke and without treatment she is will is very likely to be left profoundly disabled things can also get worse and this could even become life threatening if swelling on the brain occurs open brackets mca syndrome close brackets discussed that unfortunately she's outside the window for thrombolysis however could potentially be inside the window for thrombectomy however this is a technical decision that needs to be made by the teams undertaking it and so I discuss with them the pros and cons of this procedure they will be happy for their mom to be put forward for the test for the for the procedure for thrombectomy and therefore initial discussion with derriford at approximately 2am unfortunately 24 7 thrombectomy service is not yet running there therefore discussed with nbt in bristol who after reviewing the case felt that due to her use of a 4 wheeled walker outside her mrs was 3 and so she was not suitable for thrombectomy then therefore plan made to therefore plan made to discuss with their team via refer a patient and consider ct perfusion scanning or repeat ct scanning to consider potential transfer discussions with the new radiology registrar on call revealed that ct perfusion scanning can only be undertaken from 09:00 so we waited for the day team at 09:00 patient transferred to the scanner where ct perfusion scan undertaken the image is sent to derriford unfortunately at this time too large of a core and so not suitable for mechanical thrombectomy therefore for local management I haven't informed her sons of the outcome of our discussions it was already well past the end of my shift but I did hand over the patient to doctor simpson you can update them if they get in contact but unfortunately despite our best efforts the team felt that for technical reasons the stroke was too large to consider thrombectomy and if they did consider thrombectomy that the outcome would likely be very poor

Overnight discussions held with patient's 2 sons and son-in-law at bedside regarding CT head findings which demonstrated large vessel occlusion and significant stroke.

Explained that unfortunately this is a large stroke and without treatment she is very likely to be left profoundly disabled. Condition may deteriorate further and could become life-threatening if cerebral swelling occurs (MCA syndrome).

Discussed that patient is outside the window for thrombolysis, however could potentially be within the window for thrombectomy. Explained this is a technical decision requiring specialist assessment. Family agreed for patient to be put forward for thrombectomy assessment.

Initial discussion with Derriford at approximately 02:00. Unfortunately 24/7 thrombectomy service not yet operational. Subsequently discussed with NBT Bristol who, after case review, felt that due to patient's baseline mobility (4-wheeled walker) she was not suitable for thrombectomy.

Plan made to referapatient to Derriford and consider CT perfusion scanning. Radiology registrar advised CT perfusion only available from 09:00.

Patient transferred to scanner at 09:00 for CT perfusion scan. Images sent to Derriford for assessment. Unfortunately showed too large a core in infarct and therefore not suitable for mechanical thrombectomy.

For local conservative management. Family have not yet been updated on final thrombectomy decision outcome and no family at bedside this morning.

Summary

Investigations

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