Rural Thrombolysis for Vascular Emergencies

Thrombolyic therapy is a cornerstone treatment in time-sensitive cardiovascular emergencies, particularly rural and critical access settings where other forms of reperfusion are not available. In the rural community, percutaneous coronary intervention (PCI), embolectomy, stenting, and other interventional techniques are rarely if ever available, and decisions for intervention are often made by a solo coverage emergency physician with no other backup. However, most emergency physicians do not experience this during training and must build this expertise via direct practice. Meanwhile, the literature has rapidly evolved, with new medications, dosing recommendations, and indications emerging over the past decade.

This talk will review the literature, current guidelines, and practical realities of thrombolytic use in the rural setting. We will focus on acute myocardial infarction and pulmonary embolism as the two highest risk, most common, and highest acuity diseases that rely heavily on the bedside clinician to act decisively and correctly. However, we will touch on acute aortic syndromes, limb ischemia, and frostbite as other relevant diseases where thrombolysis may be indicated.