How quickly should a patient arriving to the ER with STEMI get to the cath lab?
30 minutes from the time symptoms start to the time the patient has engaged medical care, a diagnosis of STEMI has been made and the cardiac cath team is alerted. 30 minutes from cardiology team mobilization to patient arrival in the cardiac cath lab.
What are the emergency department goals of management for a patient with a STEMI?
The goals of prehospital management of STEMI are early recognition, administration of aspirin, and timely transport to a PCI-capable facility for reperfusion.
What is the protocol for a STEMI?
Initial medical therapy during STEMI consists of oxygen administration, antiplatelet therapy (aspirin, thienopyridines and glycoprotein IIb/IIIa inhibitors), anticoagulation, anginal pain relief with nitrates and morphine, and beta-blockade.
What is door-to-balloon time for STEMI?
Door-to-balloon time is a phrase that denotes the time between the arrival of a patient with STEMI in the emergency room until the time that a balloon is inflated in the occluded, culprit coronary artery.
How long does emergency cath lab take?
The cardiac catheterization procedure itself generally takes 30 minutes, but the preparation and recovery time add several hours to your appointment time (five to nine hours or longer). Please plan on staying at Cleveland Clinic all day for the procedure.
How long from the time the patient comes in the ER door should they be in the cardiac cath lab for best results?
First door-in to catheterization laboratory activation time within 20 minutes is associated with performing primary percutaneous coronary intervention within the national goal of ≤120 minutes for >75% of patients.
What is recommended indicated to be administered to ACS patients?
In all patients with possible ACS and without contraindications, aspirin (300 mg orally) should be given as soon as possible after presentation.
What is STEMI and Nstemi?
Non-ST-segment elevated myocardial infarction (NSTEMI) is a type of heart attack in which a minor artery of the heart is completely blocked or a major artery of the heart is partially blocked. It is less serious than a “classic” heart attack, known as an ST-segment elevation myocardial infarction (STEMI).
Do you give heparin in STEMI?
Heparin should not be considered as routine therapy for ACS and STEMI. Based on lack of clear benefit in the literature, it is not unreasonable to withhold heparin for both ACS and STEMI patients, especially in patients who are at moderate or high risk for bleeding complications.
How do nurses treat STEMI?
For patients who’ve had an ST-elevation myocardial infarction (STEMI), the standard of care is myocardial reperfusion using percutaneous coronary intervention (PCI) or thrombolytic agents. PCI is preferred, and time is of the essence.
When should PCI be administered?
Primary PCI is only indicated when symptoms duration is 12-24 hours (delayed presentation) if severe congestive heart failure, hemodynamic/electrical instability or continued angina is present. Primary PCI is not recommended when symptom onset is more than 12 hours and the patient is asymptomatic (OAT trial).
What are the challenges of STEMI care?
STEMI Care 2021. Regional STEMI systems of care with standardized STEMI protocols ensure higher PCI rates and better survival rates (upper); however, several unique challenges remain in STEMI care (bottom). EMS: Emergency medical service; PCI: Percutaneous coronary intervention; STEMI: ST-segment elevation myocardial infarction.
How can paramedics prepare STEMI patients for PCI?
With one call, the paramedic can activate a multi-disciplinary care team to prepare for primary PCI. Because only one-third of hospitals in the US are capable of PCI [16], many STEMI patients require a transfer from remote areas.
Why do STEMI patients need to be transferred?
Because only one-third of hospitals in the US are capable of PCI [16], many STEMI patients require a transfer from remote areas. One of the earliest regional STEMI systems of care, the Minneapolis Heart Institute “Level 1 MI” program, used distance from the PCI center to designate two zones with specific treatment protocols and transfer plans.
How does EMS activate STEMI?
EMS has been empowered to activate the STEMI system when transporting the patient to the nearest PCI center [14]. American College of Cardiology Foundation (ACCF)/American Heart Association (AHA) guidelines recommended training EMS staff to perform a 12-lead ECG in the field to identify STEMI patients [15].