STEMI Alert Criteria

STEMI Alert

• STEMI symptoms can be various and include: discomfort in the chest, arm, neck, back, shoulder, or jaw; syncope or near syncope; general weakness; unexplained diaphoresis; SOB; nausea/vomiting
• STEMI Alert Criteria:
  • ST-Segment Elevation in 2 or more contiguous leads:
    • Convex (frown face) or straight morphology (any of the following):
      • 2 mm or greater in V2 and V3
      • 1 mm or greater in all other leads
    • Concave (smile face) morphology
      • 2 mm or greater in any lead
  • New onset Left Bundle Branch Block
• STEMI Alert Disqualifiers:
  • The following are STEMI mimics:
    • Left Ventricular Hypertrophy (LVH)
    • Pericarditis
    • Early repolarization
      • < 2mm of elevation with a concave (smile face) morphology
    • Preexisting Left Bundle Branch Block or Pacemaker (QRS complexes > 0.12)

Cardiac Protocols

• CHF (Pulmonary Edema):
  • Signs & Symptoms:
    • Hypertension
    • Tachycardia
    • Orthopnea (SOB while lying flat)
    • Rales
    • Pedal Edema
  • Adult:
    • Obtain a 12-lead and leave cables connected
    • Nitroglycerin:
      • 0.4 mg SL, as long as BP is > 90 mmHg
      • May repeat with 0.4 mg SL
    • Contraindications:
      • SBP < 90 mmHg
      • Heart Rate < 50 beats per minute
      • EDD (Viagra and Levitra within 24 hours and Cialis within 48 hours)
      • STEMI
      • Right Ventricular Infarction (positive V4R)
• Supraventricular Tachycardia (SVT):
  • Information:
    • The distinction between Sinus Tachycardia (ST) and Supraventricular Tachycardia (SVT) can be difficult at very rapid rates
  • Adult:
    • Obtain a 12-lead and leave cables connected
    • Cardizem:
      • 15 to 20 mg IV/IO, slowly over 2 minutes, dilute in 10 mL syringe (10 mg if older than 65)
      • If no response in 15 minutes, repeat with 20 to 25 mg IV/IO, slowly over 2 minutes (20 mg if older than 65)
      • Contraindications:
        • Hypotension (BP less than 90)
        • History of WPW or sick sinus syndrome
      • Precautions:
        • Use with caution for patients taking beta blockers
        • May cause hypotension, see treatment below

Atrial Fibrillation/Flutter

• Information:
  • Rapid atrial fibrillation and atrial flutter are defined as ventricular rates > 150 beats per minute
• Adult:
  • Obtain a 12-lead and leave cables connected
  • Cardizem:
    • 15 to 20 mg IV/IO, slowly over 2 minutes, dilute in 10 mL syringe (10 mg if older than 65)
    • If no response in 15 minutes, repeat with 20 to 25 mg IV/IO, slowly over 2 minutes (20 mg if older than 65)
    • Contraindications:
      • Hypotension (BP less than 90)
      • History of WPW or sick sinus syndrome
    • Precautions:
      • Use with caution for patients taking beta blockers
      • May cause hypotension, see treatment below

Bradycardia

• Information:
  • Bradycardia is defined as a heart rate < 50 beats per minute
• Adult:
  • Obtain a 12-lead to rule out an MI and leave cables connected
  • Stable:
    • Monitor and transport
    • Obtain a glucose level
    • Treat hypoglycemia if present
  • Unstable (Hypotensive) < 90 mmHg systolic, CP, AMS, and/or SOB:
    • Atropine:
      • 0.5 to 1 mg Rapid IV/IO
      • Print ECG during administration
      • Contraindications:
        • Heart Transplant
        • Patients taking Tegretol (Carbamazepine)
        • Patients with a history of second or third-degree AV block (except in patients with a functioning artificial pacemaker)
        • Sick Sinus Syndrome without cardiac pacemaker in place
        • Active bronchospasm

Le Ventricular Assist Device (LVAD)

• Adult:
  • Unresponsive Patients:
    • Only perform chest compressions when the patient's LVAD is not working and no other options exist to restart the LVAD
    • Evaluate unresponsive patients carefully for reversible causes by assessing:
      • A.E.I.O.U.-T.I.P.S. (Patient Assessment Protocol)
      • H's & T's (Refer to Cardiac Arrest Standing Orders)
    • Check BGL
    • Chest Compressions:
      • Position hands to the right of the sternum to avoid LVAD dislodgement
      • Contraindication:
        • DO NOT use the LUCAS Compression Device
      • Precaution:
        • Performing Chest Compressions risks rupturing of the ventricular wall leading to fatal hemorrhage
  • Defibrillation:
    • If defibrillation is required, be careful not to place the pads directly over the pump