Is a broomy afternoon on your HEMS day-shift. You are called to transfer a woman 44 ys old with an ischemic stroke. She has right hemiplegia and is aphasic. The GCS is E4 V1 M5, and is uncooperative and sometimes agitated. The breathing is effective, although puffing, and the hemodynamic is compensated.
Her PMH shows depression, treated with paroxetin and alprazolam, and no other diseases. This morning she fainted, and the ambulance find her hemiplegic, aphasic and agitated. So after sedation (Midazolam), transported the patients to the local hospital where urgent systemic thrombolysis was initiated. No neurologically improvement, after five ours, from the symptoms onset.
Reason for transfer is a rescue loco-regional thrombolysis. The transfer is a 20-25 minutes helicopter (EC145) flight.
The neurology and the anesthesiologist on duty see no indication to intubate the patient.
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