Eligibility for thrombolysis and thrombectomy depends on when the patient was last known to be well. A person found with deficits on waking, or found by a relative, has a clock that started at the last time anyone knows they were normal, not when the symptoms were discovered.
Ask the family or witnesses what the patient was doing, when they last spoke normally and whether they were seen to be well after that. Write the clock time down and pass it on to the next team. Imaging selection can extend treatment for some patients with unclear onset, but that decision starts from a documented last known well.
- Ask who last saw the patient well, and when.
- Write the clock time in the notes, not a vague phrase like this morning.
- Pass the time on to the receiving team.
- Do not use the time of discovery as the onset time.
Why it matters
A vague onset time can exclude a patient who was still eligible, or include one who was not.
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