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The use of thrombolytics is indicated in the emergency department primarily during acute ischemic strokes and myocardial infarctions. Thrombolytics are medications that dissolve blood clots that obstruct blood flow to vital organs, such as the brain and heart. In the case of acute ischemic stroke, the timely administration of thrombolytics can restore cerebral perfusion, thereby minimizing neurological damage and improving outcomes for patients. Likewise, for myocardial infarctions, these agents can help restore blood flow to the heart muscle, limiting ischemic damage and reducing the risk of complications.

In contrast to this, other scenarios presented, such as a patient experiencing a seizure or undergoing routine check-ups, do not warrant the use of thrombolytics. Seizures are typically managed with anticonvulsants, and routine check-ups focus on preventive health rather than the acute interventions needed for thrombolytic therapy. Additionally, chronic headaches may require different treatment modalities that do not include thrombolytics, as these headaches do not involve acute occlusions of blood flow. Thus, the use of thrombolytics is targeted towards specific acute conditions where clot dissolution can significantly alter a patient's prognosis.