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    ME10!03!003 MMC Pathway2

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    Indra Wijaya
    This document outlines the STEMI pathway for patients presenting with chest pain. It details that for patients with ST elevation or new left bundle branch block on ECG, the cardiac catheterization lab should be activated for primary percutaneous coronary intervention (PCI). It provides guidelines for targeted history, medications, labs and IV fluids for STEMI patients. The goals are to perform the initial ECG within 10 minutes of arrival and to perform PCI within 90 minutes of arrival.

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    ME10!03!003 MMC Pathway2

    Uploaded by

    Indra Wijaya
    36 views2 pages
    This document outlines the STEMI pathway for patients presenting with chest pain. It details that for patients with ST elevation or new left bundle branch block on ECG, the cardiac catheterization lab should be activated for primary percutaneous coronary intervention (PCI). It provides guidelines for targeted history, medications, labs and IV fluids for STEMI patients. The goals are to perform the initial ECG within 10 minutes of arrival and to perform PCI within 90 minutes of arrival.

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    ME10!03!003 MMC Pathway2

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    This document outlines the STEMI pathway for patients presenting with chest pain. It details that for patients with ST elevation or new left bundle branch block on ECG, the cardiac catheterization lab should be activated for primary percutaneous coronary intervention (PCI). It provides guidelines for targeted history, medications, labs and IV fluids for STEMI patients. The goals are to perform the initial ECG within 10 minutes of arrival and to perform PCI within 90 minutes of arrival.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    36 views2 pages

    ME10!03!003 MMC Pathway2

    Uploaded by

    Indra Wijaya
    This document outlines the STEMI pathway for patients presenting with chest pain. It details that for patients with ST elevation or new left bundle branch block on ECG, the cardiac catheterization lab should be activated for primary percutaneous coronary intervention (PCI). It provides guidelines for targeted history, medications, labs and IV fluids for STEMI patients. The goals are to perform the initial ECG within 10 minutes of arrival and to perform PCI within 90 minutes of arrival.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 2

    STEMI PATHWAY

    ECG shows ST
    depression, nonspecific
    changes uninterpretible
    or is normal - follow
    local practice guideline
    for chest pain or
    R/O MI.
    And for patients with
    reasonable suspicion
    for STEMI and
    continued chest pain
    repeat ECGs every 10
    minutes

    Patient Arrival with CP


    Record Time
    Stat ECG Record Time
    (Immediate reading)
    ECG with ST elevation or
    NEW LBBB

    No

    Monitor V/S
    Adm. O2, ASA, NTG,
    MSO4
    Start 2 PIVs (per protocol)
    Request for old records

    YES
    Chest pain < 12hrs
    Record Time of Sx onset
    (see back for definition)
    YES

    No

    Consult
    Interventionalist
    REMIS 2950

    Appropriate for Primary PCI?

    Willing to consider Cath, PCI, possible short term intubation,


    defibrillation or possible CABG (5%chance)
    No
    No Prior anaphylactic contrast reaction
    No
    Adequate vascular access
    No
    Cath Lab available
    No
    Tolerate ASA, Heparin and Plavix
    No

    All Yes

    Obtain Targeted history for


    report to Interventionalist
    Bleeding disorder
    CVA
    Renal Failure
    HTN
    Recent Surgery (2wks)
    Bleeding
    Severe PVD limiting access
    Diabetes

    No
    No
    No
    No
    No
    No
    No
    No

    Yes
    Yes
    Yes
    Yes
    Yes
    Yes
    Yes
    Yes

    Activate the Cath Lab


    REMIS 2950

    Yes
    Yes
    Yes
    Yes
    Yes

    Any No

    Consult
    Interventionalist
    REMIS 2950

    ED Attending
    receives call from
    Interventionalist

    Initiate Heparin, Plavix and Stat labs (per protocol on back)


    Prepare pt. transfer to Cath Lab
    Transfer with 2 licensed medical staff

    April 2012

    Patients Emergently Reperfused by Facilities United for STEMI Excellence


    Symptom Onset Definition
    For patients reporting symptoms initially intermittent and subsequently constant, the onset time is
    defined as the time of change from intermittent to constant symptoms.
    Patients reporting symptoms that were initially mild and subsequently changed to severe, the
    onset time is defined as the time of change in symptom severity.
    For patients with both, the change in symptom severity is given preeminence in determining
    symptom onset time.
    ~AHA/ACC definition

    PHYSICIAN ORDER GUIDELINES FOR THE STEMI PATIENT


    Ancillary
    ECG 12 Lead STAT every 10 min with continuing CP
    RN pulse oximetry, adjust oxygen flow to obtain saturation above 95%
    Laboratory
    CBC STAT
    Troponin T STAT
    CMP STAT

    CK/CKMB STAT
    PTT STAT
    PRO Time STAT

    IV Fluids
    Periph Line #1. Start 0.9% N/S 1000 ml @100 ml/hr until D/C. Use 32 extension set
    Periph Line #1 Start Nitroglycerin concentration B, (400 mcg/ml D5W)(100mg/250ml)
    Titrate to SBP 90 and pain, Cont. until D/C
    Medications
    Aspirin 325mg STAT
    Heparin Inj 60 u/kg IV push Now (maximum dose 4000u)
    Metoprolol 5mg IV push every 5 minutes Times 3 as tolerated**
    Plavix 600 mg P.O. now
    Physician to Nurse
    Record estimated height, weight, and allergies
    Time permitting
    Have patient void before leaving for Cath Lab
    Foley catheter at patient request PRN
    Mark peripheral pulses
    Prepare patient for cath Lab, no clothing, plastic snap gown, portable 02 and monitor
    **Consider BB for hypertensive patients
    Important occurrences to document and time benchmarks
    1. ED Arrival
    2. Mode Patient arrived in ED ( PV, EMS w/ECG, EMS w/o ECG)
    3. 1st ECG time, subsequent ECG times, 1st ECG time when STEMI is diagnosed
    4. Any delays that occur in ED Pt refusal, cardiac arrest, intubation, etc.
    5. Time patient departs the ED
    Time goals Time is Muscle!
    ED arrival to ECG within 10 minutes
    Door to Balloon within 90 minutes

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