Hello, med students. My name is Zach Olson and thank you for downloading this week's episode of the EM Clerkship Podcast.

This week, we are discussing a somewhat random topic.

We're going to be talking about TPA, the core treatment right now for ischemic stroke. Some of that might change,

but right now it's the core treatment. Despite the outcry of many brilliant physicians

who oppose the widespread use of TPA, it still somehow became a begrudged standard of care for us in the United States.

In adults with acute, eschemic stroke who meet certain criteria, we give TPA.

That's what all of these stroke alerts are about.

It's about getting TPA in as soon as possible, hopefully less than 60 minutes

from when the patient presents. Physiologically, how this is supposed to work is that TPA

activates plasmin, and then that plasmine breaks down fibrin.

That glue holding the blood clot together is made up of something called fibrin.

And the plasmin breaks down that fibrin clot into little d-dimers.

That's why we give TPA.

It sometimes does work.

Doing this has been shown to improve long-term outcomes in some studies.

The numbers vary, but the TPA itself supposedly adds about an extra 12% chance of improvement

three months out.

But there is also about a 6% chance of causing horrible, devastating, bleeding, which we're

going to talk about next week.

That's TPA.

It's very high risk, high reward, 12% benefit, 6% risk, if you believe the numbers cited by the pro-TPA

people who control the current medical environment. The most important thing today, though,

...