STEMI Bypass Protocol Flashcards
What indicates an acute MI/ STEMI?
i. at least 2 mm ST-elevation in leads V1-V3 in at least 2 contiguous leads; AND/OR
ii. At least 1 mm ST-elevation in at least 2 other anatomically contiguous leads; OR
iii. 12 lead ECG computer interpretation of STEMI and paramedic agrees
Assess the patient to determine if they meet all of the following indications:
a. >18 yrs of age
b. experience chest pain or equivalent consistent with cardiac ischemia or MI
c. the time from onset of the current episode of pain <12 hrs; and
d. the 12-lead ECG indicates an acute MI/STEMI, as follows
Then assess the patient to determine if they have any of the contraindications…
a. Pt is CTAS 1 and paramedic is unable to secure airway or ventilate
b. 12 lead ECG is consistent with a LBBB, ventricular paced rhythm, any other STEMI imitator
c. Transport to a hospital capable of PCI >60 mins for pt contact
d. The pt is experiencing a complication requiring PCP diversion
e. The pt is experiencing a complication requiring ACP diversion
What are some complications that require PCP diversion?
a. moderate to severe respiratory distress or use of CPAP
b. Hemodynamic instability or symptomatic SBP <90 mmHg at any point; or
c. VSA with no ROSC
If the pt doesn’t meet the contraindications OR the interventional cardiology program permits the transport
- Inform CACC of the need to transport to a PCI centre
What should you provide the PCI centre with?
b. Pt is a “STEMI Pt”
c. Pt’s initials
d. Pt’s age
e. Pt’s sex
f. Paramedic’s concerns regarding clinical stability
g. Findings on the qualifying ECG
h. ETA
i. catchment area of the pt pickup
Upon arrival at the PCI centre, provide what info to the PCI centre staff?
a. Time of symptom onset
b. Time of ROSC, if applicable
c. hemodynamic status
d. meds given & procedure
e. hx of MI/ PCI/ Coronary artery bypass graft, if applicable
f. copy of qualifying ECG
g. Copy of ACR
