STEMI Management

Question 1

What is the care objective for STEMI management?

Answer 1

1. All efforts should aim to expedite coronary reperfusion via PCI or PHT. Primary destination in all cases is a PCI.

Question 2

Time from onset of symptoms to coronary reperfusion correlates to…

Answer 2

The amount of permanent myocardial damage and risk of death.

Question 3

If a 12 Lead identifies potential STEMI but there is reason to believe this is incorrect then…

Answer 3

Cardiology consult service must be contacted.

Question 4

With respect to thrombolysis, the time to PCI facility is determined by…?

Answer 4

The time at which the 12 Lead ECG changes are identified by a PHT endorsed and equipped paramedic.

Question 5

If STEMI for <12 hours identified, what are the initial ALS actions?

Answer 5

1. Transmit ECG
2. Request MICA
3. Treat as per ACS
   (apply defib pads to all STEMI pts)

Question 6

When is PHT not indicated?

Answer 6

If time to PCI <1hr
If pt does not meet all inclusion criteria
If pt meets any exclusion criteria

Question 7

When is PHT indicated?

Answer 7

Time to PCI >1hr
Pt meets all inclusion criteria
Pt does not meet any exclusion criteria

Question 8

Following the “Urgent Transport to PCI Facility” arm of this guideline, what is the STOP note?

Answer 8

1. If uncertain on STEMI Dx or PHT, call consult
2. ALS paramedics must call cardiology consult prior to Heparin admin
3. Do not delay transport

Question 9

Following the “Urgent Transport to PCI Facility” arm of this guideline, what is the Action?

Answer 9

Continue ACS management
Transport with hospital notification
Heparin 4000IU bolus, rpt @1000 IU 1 hrly
Capture rpt. ECG 30mins prior to hospital, transmit with notification

Question 10

Following the “Pre-Hospital Thrombolysis” arm of this guideline, what is the STOP note?

Answer 10

1. Must call cardiology consult prior to PHT

2. MICA must call cardiology where relative C/I present

Question 11

Following the “Pre-Hospital Thrombolysis” arm of this guideline, what is the Action?

Answer 11

2 x IV access, normal saline TKVO
Complete checklist, read information statement
Tenecteplase IV bolus
Heparin IV bolus 4000IU, rpt every hour
Transport w/ hospital notification, transmit 12 Lead
Recapture 12L 30 mins prior to arrival, transmit with notification