Can I run a case by YouTube that just came in? I've got this 80-year-old woman with a history of hypertension on an aescent aspirin who had a sudden onset of dense right hemipelija and facial droop that started four hours ago. Her pressure is 190 over 100, a bit over the license caught off, right? Anyways, her husband is asking me, built lysis. It'll take at least an hour to get her to the stroke center, and by the time they image her, she'll probably be outside the window for systemic lysis anyhow. And her pressure would have to be lowered before they do that. Anyways, should I transfer her? Should I scan and lice her here? Yeah, that's a tough one, man. I probably protect my behind and sender. You really have nothing to lose.

No way. I'm with Jerry Hoffman on this one. Lysis for stroke is a hoax. Especially when you're nearing the long end of the time window.

Defensive medicine is for wimps. It's all about shared decision making. Have a conversation with a husband.

As far as I'm concerned, it's a toss-up between a small increase in her chance of death

against a possible functional benefit if she doesn't die.

So, it's a personal choice.

Hmm, decisions, decisions.

I'm Anton Hellman.

And I'm Teresa Chan.

I'm Justin Morganstern.

And I'm Rory Spiegel.

And this is the Journal jam podcast.

Now you might be thinking,

why are we embarking on this topic of Liddix for Stroke?

Hasn't it all been covered before?

Yeah, well, Anton, I guess a few months ago,

I was on shift dealing with a similar case to the one discussed at the top of the podcast when I

stumbled upon changes in the package insert of TPA for CVA. And quite frankly, I was shocked.

All the strict previous contraindications to Lytics for stroke have vanished based on as far

as I can tell, no real data. And maybe I'm just a bit sensitive now in the current post-truth reality,

but with the disappearance of SmartEM and the semi-retirement of Dr. Jerome Hoffman,

who spent a career discussing the flaws in the literature

...