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PR58: PCP STEMI Clinical Workflow
Applicable To
Introduction
A STEMI (ST Elevation Myocardial Infarction) is a myocardial infarction caused by acute interruption of coronary blood flow. Timely recognition and treatment of STEMIs dramatically improves patient outcomes.
Indications
***STEMI*** flag on 12-lead ECG
Contraindications
Procedure
If 12 lead ECG flags ***STEMI*** and a local PCP STEMI Pathway Exists:
- Regional STEMI Clinical Pathways
- Follow local STEMI Clinical Pathway
- Transmit 12-lead
- Notify Receiving facility using ATMIST
- Request ACP intercept where available (do not delay on scene awaiting ACP)
- Apply therapy electrodes (AED pads).
- Ensure the monitor is not on the 12-lead screen unless actively acquiring a 12 lead.
- If your patient meets exclusion criteria for local STEMI Pathway, consult CliniCall if necessary and transport to closet hospital.
If 12 lead ECG flags ***STEMI*** and a local PCP STEMI Pathway DOES NOT Exist:
-
- Request ACP intercept where available (do not delay on scene awaiting ACP),
- Apply therapy electrodes (AED pads),
- Notify receiving hospital using ATMIST, as soon as practical
- Identify yourself as a PCP
- Tell them you have flagged a prehospital STEMI and your ETA,
- Ensure the monitor is not on the 12-lead screen unless actively acquiring a 12-lead
Notes
If 12 lead does not flag STEMI, but flags ***ACUTE MI*** the PCP STEMI Pathway is NOT activated. If the 12 lead flags ***ACTUE MI*** you should have a high index of suspicion of an evolving acute event, follow the steps below:
- Request ACP intercept where available
- Consult CliniCall
- Repeat 12-lead every ten minutes
- Ensure the monitor is not on the 12-lead screen unless actively acquiring a 12-lead, the monitor will not flag life threatening arrhythmias while on the 12 lead screen
- If on repeat ECG, it flags ***STEMI*** - follow regional STEMI Pathway if safe to do so.