Mr. Q, a 72-year-old right-handed man with hypertension, hyperlipidemia, recurrent angina, and a 30 pack-year smoking history is a retired scientist living in the United States with his wife. He recently visited his native country, Ukraine, for the first time in almost 30 years. After an emotional day with family members, he returned home and suddenly became diaphoretic and weak, and ultimately lost consciousness. His wife drove him to the nearest open medical clinic. Because it was severely underresourced, he was then emergently taken by ambulance to a larger hospital 6 hours away. He regained consciousness by the time he arrived at this second hospital. After he was examined, his wife was told that, as a consequence of an acute stroke, her husband would no longer be able to move the left side of his body or produce speech. The physician explained that nothing could be done because the pharmacy was closed and that Mr. Q might not survive. His wife insisted that she could "pay with dollars" and that the pharmacy be opened. The physician then provided her with a list of 3 medications, which she obtained at this pharmacy (after it opened at her insistence) and swiftly brought back to the hospital. She described how her husband received a yellow powder that was then mixed in saline and administered IV. The second and third medications were clear liquids delivered IV and subcutaneously, respectively. Mr. Q also received IV fluids, and over the next 2 hours, the patient's strength and language functions recovered to baseline. He continued to receive care at this hospital and received his first head CT scan on his fourth hospital day. Upon discharge, he and his wife quickly flew back to the United States.
Original Article: http://www.neurology.org/cgi/content/short/83/19/e174?rss=1
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