Tuesday, November 04, 2008

STEMI (ST-Elevation Myocardial Infarction)

Dispatch: 8:07 Chest Pain
Enroute: 8:08
On Scene: 8:14
At Patient: 8:15

66-year-old female with 3 out of 10 chest pain X 2 hours. Periodic chest pain for last week. Skin warm and dry. No prior heart hx.

Initial 3-lead strip: 8:16



Vitals, 02 by cannula. 324 ASA PO. Patient shirt removed, put in hospital gown

Initial 12-Lead: 8:19 (Watch V4 in particular, as well as V1-V3 over course of ECGs)



IV # 18 in left AC. 0.4 NTG SL

Depart Scene: 8:21

Hospital called for official STEMI Notification: 8:22

2nd 12-lead ECG: 8:22 (Note LP12 spitting out 12-leads every three minutes.



8:23 2nd NTG SL. 2nd IV # 18 in right AC

(In meantime hospital alerting cath lab team)

8:25 3rd 12-Lead ECG



8:26 Cath Lab team arrives in ED

8:28: 4th 12-Lead ECG Pain now up to a 5.



Begin preparing patient for quick exit from ambulance

8:31 5th 12-Lead ECG



8:34 Out at Hospital

8:35 Transfer Care to ED Doc/medical staff/ cath lab team

8:36 Hospital ECG



Next ten minutes Patient is prepped(additional drugs, procedure discussed, consent given) and then hustled upstairs.

8:50 Patient hits cath lab table.

9:08 Balloon inflated (Hospital Door to Balloon Time - 34 minutes).

Patient has 100% occlusion of Left Anterior Descending artery (The Widowmaker). Suffers arrhythmia. V-Tac. cardio-verted X 1. Then full reperfusion.

Normalized ECG.

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First there were hospitals, then ambulances, then emergency departments, then EMTs, then paramedics, then prehospital ECGs, and then STEMI alerts with cath lab notifications.

Progress

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Paramedics Activate Cath Lab for STEMI Patients in Some Areas