[05.20.2023] Updated content, AnKing Overhaul for Step 1 & 2/AnKingMed, ID 405316

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@herstein.jacob @Cameron @shmuelsash @Sameem @Tahseen @Bilal @StanG

Didn’t we just change this recently for some other card?

Support. Is it a dupe, cause I remember this too. Also why can’t we do after 120 mins? I mean unless the Q waves have developed, we have to go for myocardial salvage.

“ If the total door to balloon time, including transport, will be > 120 min, treat patient with fibrinolytic therapy, such as alteplase, if there are no contraindications, within 30 min from the onset of symptoms, and then transport patient to a hospital with PPCI capacity in case fibrinolysis does not work or the patient develops recurrent infarction.”

It’s a bit confusing. We can go for PCI even after 120 mins, especially if there are contraindications to fibrinolytic therapy. It’s just that after 120 mins the both have kinda similar efficacy.

I think the idea here is that the there is greater benefit in providing tPA earlier (<30min) versus waiting to do a PCI later (>120min). Additionally, all patients - who do not get a PCI - should have received tPA well before 120min. In that case, I think tPA administration would be a relative contraindication for PCI in the near term due to bleeding risk. Unless of course the patient further decompensates with anticipated mortality; at which point nothing is really contraindicated and everything - ethical - is permitted.

For the sake of consistency with nid:1543518218894, I think we can push this