AMI / STEMI protocols

[EM2BE]

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I am trying to find different protocols that exist for different hospitals regarding STEMIs and other kinds of AMIs. Can anyone post specific protocols or at least identify when their hospitals will send someone straight to cath lab, hold in ED for testing prior to cath, or no cath? Or any other options you all have would also be appreciated.

Thanks!

 

[docB]

At my hospitals when we call a code STEMI several things happen:
-A specific interventional cardiologist is called regardless of the patient's insurance (ie. we don't call a contracted cards group for an HMO patient) or their private cardiologist. This is done to save time.
-The cath lab team is mobilized.
-Lab, Xray and EKG respond to the bedside.

We don't roll the patient to the lab on the EMS gurney. We shoot the chest, draw the labs and do the EKG in the ED. We do activate the code based on the EMS report (we don't have tele yet, coming soon we're told).

 

[Arcan57]

STEMI = CODE STEMI unless patient or family specifically request not to go to cath lab. We give lytics about once every 2-3 years, usually because the cath lab is full.

Direct admits sometimes go straight to cath lab, everyone else (squad or walk-in) is seen in ED first. There's something pathologic about our paramedics lack of understanding of what constitutes a STEMI. I've had reports of ST-elevation in II, AVR, and V6, LBBB in someone with a complaint of back spasm after mechanical fall (described as elevation in V1-V4, with depression in V5-6), and numerous non-specific ST-T wave changes (usually artifact). We're supposed to be getting tele EKGs emailed to our server sometime this year.

Code STEMI activates radiology and phlebotomy although usually not the cardiologist or the cath lab (protocol says page team, unit coordinators sometimes don't because they afraid of the cath lab yelling at them if the Code STEMI is canceled). They get ASA, heparin (after CXR), nitro, morphine +/- IV beta-blocker (being phased out). Plavix or IIb/IIIa inhibition remains a cards call typically made in the cath lab. Patient's private cardiologist (if they have one) or interventionalist on call is paged. We have several big groups that don't play well with each other, so the one-call system hasn't been implemented.

 

[BADMD]

I am trying to find different protocols that exist for different hospitals regarding STEMIs and other kinds of AMIs. Can anyone post specific protocols or at least identify when their hospitals will send someone straight to cath lab, hold in ED for testing prior to cath, or no cath? Or any other options you all have would also be appreciated.

Thanks!

In our ED, when the attending physician calls STEMI, the patient goes to the cath lab. If there is no IV in place, they go without. We don't wait for blood to be drawn, xrays, heparin or anything else. We don't even wait for the Interventionalist to call back. The patient goes. The cath lab is notified as the patient is going up.

 

[dchristismi]

My setup sounds similar to DocB's.

At my shop, all EKGs are handed to a doc for a sign-off within minutes. We no-likey, they come back ASAP if they've been in triage; if they came in via EMS, they are seen right away.

We get "Code STEMIs" from EMS. We actually use "ACS" as our in-house nickname. As in, if I decide I don't like what I'm seeing, I page the "ACS cardiologist on call" as well as the cath team. Cards generally calls back quickly, we give the story. If it's iffy we'll fax the EKG to cards, but often they'll just ask if we think it's the read deal. If so, it's usually heparin and away they go. (Our cards guys like to reserve plavix as they are doing some studies at the moment, so ntg, asa, heparin, 2 lines if possible, CXR and pacer pads are what we do.)

I caught a dissection masquerating as a posterior MI a couple of months ago, and got him on the scanner table before the (rather-pissed-that-said-pt-wasn't-on-the-cath-table-already) cardiologist showed up. There were a tense couple of minutes there...