Cardiac Receiving Capability

Question 1

Requirements for a STEMI Receiving Facility

Answer 1

1. Must be recognized by AZDHS by having PCI (percutaneous coronary intervention) Capability 24/7

Question 2

What is Percutaneous Coronary Intervention?

Answer 2

AKA a Coronary Angioplasty w/ Stent, is a minimally invasive procedure that improves blood flow to the heart by opening narrowed or blocked coronary arteries. PCI is usually performed in a cath lab that has an X-ray machine

Question 3

Procedure for a PCI

Answer 3

Performed by a Cardiologist, He/She:

1. Inserts a small, hollow tube (sheath) through a blood vessel in the arm or thigh
2. Guides a catheter through the sheath and into the heart
3. Injects a contrast dye and uses X-rays to see the catheter in real time
4. Opens the blocked artery by inflating a balloon at the tip of the catheter
5. Places a stent, if needed, to keep the artery open

Question 4

How can a Facility lose it’s “STEMI Receiving” status?

Answer 4

SAEMS Regional Council can remove a facility if:

1. There are more than 7 occurrences or days of STEMI divert for any reason, over the course of a 14-day period
2. If there are more than 20 occurrences or days of STEMI divert in a 60- day period

Question 5

How can a Facility Regain “STEMI Receiving” Status again?

Answer 5

ED Director will need to provide documentation to the SAEMS Executive Director & SAEMS Regional Council that they have:

1. Regained their credentialing (if lost)

-OR-

2. Have adequately addressed issues with lack of coverage & are able to maintain 24/7 coverage

Question 6

How are ACS or NSTEMI’s treated?

Answer 6

Same PCI procedures & use of Thrombolytics/Fibrinolytics

*All true Chest Pain complaints warrant an evaluation

Question 7

How are all complaints evaluated?

Answer 7

VIA a Coronary Angiography to see level of occlusion

Question 8

First Line of TX for STEMI’s?

Answer 8

If w/in 12 hours of Onset:

PCI > Fibrinolytics

Question 9

National Goal for a PCI

Answer 9

1. Door-to-Ballon time must be w/in 90 minutes
2. W/in 120 minutes from EMS to Device time

Question 10

National Goal for Fibrinolytics

Answer 10

1. Door-to-Needle must be w/in 30 minutes
2. W/in 12 hours of chest pain onset when PCI is unavailable (contraindicated if after 12 hours due to risk of brain bleeds)
3. Used for Posterior MI’s

Question 11

Available TX’s for MI’s

Answer 11

1. PCI (Percutaneous Coronary Intervention)
2. Thrombo-/Fibrino-lytics
3. Coronary By-pass Graft

Question 12

If all TX fails…

Answer 12

Coronary By-pass Graft

1. CAD/ACS cannot be managed by meds
2. LCA or 3 Vessels are occluded
3. PCI failed or not possible
4. HX of Diabetes, CKO, LV dysfunction