stemi case studies - american heart associationwcm/@mwa/documents/...stemi case studies ashlee...
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SE REGION
STEMI CASE
STUDIES
ASHLEE ROSTVEDT RN, BSN
STEMI PROGRAM COORDINATOR
ESSENTIA HEALTH - FARGO
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CASE #1
• 63 y.o. female
• Hx: tobacco use and HLD
• Became nauseated and
syncopal while working
at a local technical
college
• Bystanders called 9-1-1
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CASE #1
Pre-Hospital 12-Lead ECG:
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CASE #1
Pre PCI Post PCI
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CASE #1
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Regional Systems of STEMI Care,
Reperfusion Therapy, and Time-to-
Treatment Goals
Performance of a 12-lead
ECG by EMS personnel at the
site of FMC is recommended
in patients with symptoms
consistent with STEMI.
I IIa IIb III
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CASE #2
• 33 y.o. male
• Hx: smoking
• Presented by private
vehicle to PCI center
ED with c/o chest pain
x 2.5 hours
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Initial ECG - 01:39
CASE #2
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Repeat ECG - 01:59
CASE #2
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CASE #2
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CASE #2
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CASE #3
• 87 y.o. female
• Hx: CAD, CABG, HTN, PVD,
and recent NSTEMI with
stenting to bypass graft
• Presented by private vehicle
to referring hospital ED after
sudden onset of 10/10 chest
pain, nausea, and diaphoresis
while eating lunch at
McDonald’s
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CASE #3
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CASE #3
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CASE #3
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CASE #3
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CASE #4
• 58 y.o. male
• Hx: smoking, HTN
• Presented by private
vehicle to referring
hospital ED with
progressive, stabbing
chest pain that began 4.5
hours prior
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CASE #4
Minutes after arrival (and prior to ECG), patient
became unresponsive and went into ventricular
fibrillation/respiratory arrest
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CASE #4
Patient received compressions via the
LUCAS device!!
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CASE #4
ECG was completed after ROSC…
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CASE #4
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CASE #4
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CASE #4
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NOT A LYTIC CANDIDATE
OR EVIDENCE OF CARDIOGENIC
SHOCK??
• These patients are at extremely high risk.
• Fibrinolytic agents work best with adequate
blood pressure and flow to the coronaries.
• Primary PCI is preferred as soon as possible.
Transfer ASAP to PCI-capable center!!
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Primary PCI in STEMI
Primary PCI should be performed in
patients with STEMI and ischemic
symptoms of less than 12 hours’
duration who have contraindications to
fibrinolytic therapy, irrespective of the
time delay from FMC.
I IIa IIb III
Primary PCI should be performed in
patients with STEMI and cardiogenic
shock or acute severe HF, irrespective of
time delay from MI onset.
I IIa IIb III
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DOCUMENTATION
REMINDERS
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Complete and accurate
documentation along
all steps of the STEMI
system of care is
essential!!
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HOSPITAL DOCUMENTATION
GUIDELINES
Please Document Times:
1. _____________ Initial Chest Pain Onset Pain Scale 0-10 (10 being severe)
2. _____________ Pre-Hospital ECG time (if available)
3. _____________ Referring Hospital Arrival (Door – In)
4. _____________ Referring Hospital 1st ECG Time
_____________ 2nd ECG Time
5. _____________ Time Transport Activated
6. _____________ STEMI Alert Activation (STEMI Receiving Hospital contacted)
7. _____________ EMS Transport Arrival Time
8. _____________ Referring Hospital Departure (Door-Out)
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Upon Transfer Fax the following documents
to the accepting facility:
12 L ECG
ED Record
Lab Results
Current Medication Record
ND M:L STEMI RUSH documentation
HOSPITAL DOCUMENTATION
GUIDELINES
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• Use RUSH Protocol to quickly document
all important times during the STEMI alert
(may add to EMR later)
• Copy RUSH Protocol and fax to receiving
facility (will be used to create feedback
form and track metric performance)
• Verify that all clocks/computers are
synced to the same time
HOSPITAL
DOCUMENTATION TIPS
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EMS TRANSPORT GUIDELINES
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EMS DOCUMENTATION
GUIDELINES
Documentation Reminders:
Provide copy of EMS run sheet (including
run times) with report to RN or MD
If STEMI/AMI alert is provided to the
hospital, document the time
Provide a printed copy of pre-hospital 12 L
ECG with report to RN or MD
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QUESTIONS?
Thank you for your time and your
commitment to providing
excellent STEMI care!!