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Thrombolysis in acute ischaemic stroke: example of a health divide?

BMJ 2010; 340 doi: (Published 06 January 2010) Cite this as: BMJ 2010;340:c45
  1. Hyun Choi, specialist trainee year 1, department of general medicine, Trafford General Hospital, Manchester
  1. hchoi{at}

    It is 3 am in the emergency department of a busy London teaching hospital. A red phone alerts the team that an ambulance is bringing in a man with a two hour history of slurred speech. A stroke registrar who is on call and based on site is fast bleeped to resuscitation. An emergency doctor, resuscitation nurse, and stroke registrar are present when the patient arrives. Primary and secondary surveys, along with basic bedside investigations, and then monitoring are rapidly executed in a beautifully choreographed manner, and urgent computed tomography of his head is performed after a discussion with a radiology registrar, who is also based on site. Less than 40 minutes elapse from the patient’s arrival to the head scan. A radiology report is available instantly, and a decision is made to thrombolyse.

    It’s 4 pm in a busy district general hospital in the north of England. An emergency doctor refers a middle aged man with a three hour history of right sided hemiplegia. Although the patient …

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