Chest Pain (Non Traumatic) Standard

Question 1

What are potential LIFE/LIMB/FUNCTION threats in this directive?

Answer 1

Pneumothorax
Aorta (dissecting)
Pericarditis
Pulmonary embolism
Acute coronary syndrome (MI or STEMI)

Question 2

What should we do as soon as we hear CHEST PAIN!?? (to rule out the life threats)

Answer 2

12 LEAD ECG

Question 3

What are we assessing on the chest during our secondary survey?

Answer 3

subcutaneous emphysema
accessory muscle use
urticaria
in drawing
shape
symmetry
tenderness

Question 4

What other assessments should we perform on this chest pain patient?

Answer 4

LUNG ASCULTATION
Assess:
- abdomen ((as per abdo standard)
- neck (tracheal deviation/ JVD)
- extremities (leg/ankle edema)

Question 5

What are the INDICATIONS for STEMI bypass protocol?

Answer 5

– over or equal to 18!!!
– experience chest pain or equivalent with cardiac ischemia or myocardial infarction
– the time of onset is >12 hours!!
– the 12 lead electrocardiogram indicates a STEMI

Question 6

What are the contraindications of STEMI bypass protocol?

Answer 6

CTAS 1 pts and medic cannot secure airway or ventilate

12 lead shows LBBB, ventricular paced rhythm or any other STEMI mimicker

transport to a hospital PCI >=6o mins from pt contact!! (ASK WHERE PCI IS AT START OF SCENARIO)

The pt is experiencing a complication requiring PCP diversion as follows:
- mod-severe resp distress or CPAP
- Hemodynamic instability or symptomatic SBP <90mmHg at any point
- VSA without a ROSC!!

The pt is experiencing a complication requiring ACP diversion as follows:
- ventilation inadequate
- hemodynamic instability unresponsive to advanced care
- VSA without ROSC

Question 7

So now that you have the ALL clear to go to a PCI, what information should we provide the receiving hospital????? (STEMI hospital)

Answer 7

• that the pt is a STEMI patient
• the patient’s initials
• the patients age
• the patients sex
• the paramedics concern regarding clinical stability
• infarct territory
• ETA
• catchment area of patient pickup

Question 8

When you get to receiving facility what are things you should be reporting to PCI centre staff????

Answer 8

• time of symptom onset
• time of ROSC if applicable
• hemodynamic status
• meds given and procedure
• hx of acute myocardial infarction/PCI/Coronary artery bypass graft, if applicable
• copy of ECG
• copy of ACR

Question 9

Once a STEMI is confirmed what should the paramedic right away???

Answer 9

APPLY DEFIB PADS
***due to potential lethal cardiac dysrhythmias

Question 10

If IV access is permitted then what arm is the preferred for the cannulation site?

Answer 10

LEFT ARM

Question 11

If a ECH becomes STEMI positive en route to a NON PCI, what do medics do??

Answer 11

Consider STEMI bypass protocol and inform CACC of change of route!!!!