Mission: Lifeline North Texas STEMI Workshop. The Model STEMI Referring Center (non-pci capable) Trisha Wren, RN, BSN

Transcription

1 STEMI Workshop The Model STEMI Referring Center (non-pci capable) Trisha Wren, RN, BSN

2 Faculty Disclosure Information Trisha Wren, RN, BSN The Model STEMI Referring Center (non PCI capable) FINANCIAL DISCLOSURE: None UNLABELED/UNAPPROVED USES DISCLOSURE: None 10/8/ , American Heart Association 2

3 The Ideal System of Care , American Heart Association

4 The Ideal Referral Hospital Standardized POE protocols dictate transport of STEMI patients directly to a receiving hospital based on: Specific criteria for risk; including cardiac arrest Contraindications to thrombolysis The proximity of the nearest PCI service Patients presenting to a referral hospital are treated according to standardized triage and transfer protocols Initiates hypothermia as soon as possible, when indicated Transports early patients resuscitated from OHCA to Receiving Center to allow angiography of Cath eligible/appropriate patients as soon as possible to achieve goal of first door to device within 120 minutes Implements and maintains ability to treat re-arrest including mechanical CPR AND/OR pharmacological support if indicated 2011, American Heart Association 4

5 The Ideal Referral Hospital (continued) Incentives are provided to rapidly: Treat STEMI patients in accordance with ACC/AHA guidelines Transfer to a STEMI-receiving hospital for primary PCI using: Reperfusion checklists Standard pharmacological regimens and order sets Clinical pathways There is rapid and efficient data transfer, data collection and feedback Integrated plans for return of the patient to the community for care are provided Provides CPR training for community, with goal of achieving bystander CPR rates > 50% 2011, American Heart Association 5

6 Goals/Barriers Door to ECG Goal <10 minutes Barriers Busy ED Lack of Education/Awareness Lack of Equipment Recognition of atypical symptoms Communication between staff Convenience of staff

7 Goals/Barriers Primary PCI Goal: DIDO <30 minutes Goal: D2D2B <120 minutes Thrombolytics Goal: Door to Needle <30 minutes Barriers Busy with other critical patients Lack of appropriate staff Weather Difficulty with transfer process Lack of collaboration with EMS Multiple PCI facility protocols Delay in ECG completed

8 Actions Public Education on signs and symptoms of ACS and calling 911 Dispatch Education on signs and symptoms of ACS Give reason when transferring a STEMI patient with ground EMS Improved partnerships with EMS Monthly meeting EMS activates Code STEMI from the field based on their interpretation of ECG Perform Thrombolytic Checklist PTA Set goals for DIDO times for EMS Drills Weather check

9 Actions ED Staff/Registration Educate on the goals and importance of prompt ECG and treatment Annual education to the ED registration staff/volunteers on symptoms of ACS and process to follow Created STEMI protocol/code STEMI STEMI Medication Tackle Box PCI Facilities Set up one call acceptance with different facilities Receive follow up information

10 , American Heart Association Mission: Lifeline North Texas Case Study #1- Door to Door to Balloon Patient: 34 yr old Male Chief Complaint: Chest Pain History of Present Illness: Patient came to ED by POV c/o chest pain started one hour PTA. Pain was primarily located in the substernal area with radiation to left shoulder and left back. Also c/o SOB and n/v. Rates pain as 10/10. Past Medical History: Family history CAD, HTN, Quit smoking 2 years prior

11 Case Study #1- Door to Door to Balloon Door to ECG: 7 minutes DIDO: 39 minutes D2D2B: 94 minutes

12 Case Study #1- Door to Door to Balloon PCI FACILITY PLAD stent Proximal left anterior descending artery (PLAD) occlusion 1 st Diagonal stent

13 , American Heart Association Mission: Lifeline North Texas Case Study #2- Door to Needle Patient: 50 yr old Male Chief Complaint: Chest Pain History of Present Illness: Patient came to ED by EMS c/o chest pain started PTA. Pain is primarily located in the substernal area with radiation to the left arm, left shoulder, left neck, left jaw. Also c/o SOB, dizziness, nausea. Rates pain as 5/10. Past Medical History: DM, HTN, CAD, CHF, Cigarette smoker-1.5 packs daily

14 Case Study #2- Door to Needle EMS RESPONSE Dispatched for chest pain. Treatment: 1 st 12 lead did not show ST elevation. 2 nd ECG showed elevation in inferior leads Oxygen ASA 324mg PO Nitro 0.4mg SL 2 IV sites FMC to ECG: 6 minutes Total Scene Time: 15 minutes Activated Code STEMI

15 Case Study #2- Door to Needle Door to ECG: 0 minutes Door to Needle: 24 minutes

16 Case Study #2- Door to Needle PCI FACILITY DRCA stent DRCA 80% with thrombus