STEMI Alert Criteria
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Questions and Answers

What is the contraindication for administering Aspirin in a patient with chest pain?

  • Tachycardia
  • Hypertension
  • Active GI bleeding (correct)
  • Pulmonary edema

    • What is the primary reason to obtain a 12-lead ECG in a patient with CHF?

  • To diagnose STEMI
  • To identify signs of right ventricular infarction (correct)
  • To assess lung sounds
  • To monitor the patient's BP

    • What is the indication for referring a patient to the Cardiogenic Shock Protocol?

  • Pulmonary edema and hypotension (correct)
  • Pedal edema and CPAP use
  • Orthopnea and rales
  • Hypertension and tachycardia

    • What is the contraindication for using CPAP in a patient with CHF?

    <p>SBP &lt; 90 mmHg</p> Signup and view all the answers

    What is the dose of Nitroglycerin that can be administered to a patient with CHF?

    <p>0.4 mg SL</p> Signup and view all the answers

    What is the primary concern when using Nitroglycerin in a patient with CHF?

    <p>SBP &lt; 90 mmHg</p> Signup and view all the answers

    What is the indication for administering Aspirin in a patient with chest pain?

    <p>With or without chest pain</p> Signup and view all the answers

    What is the specific caution required when using Nitroglycerin in a patient with a history of EDD?

    <p>Avoid using Nitroglycerin within 24 hours of EDD</p> Signup and view all the answers

    Which of the following is a STEMI symptom?

    <p>General weakness</p> Signup and view all the answers

    What is the criteria for STEMI Alert?

    <p>ST-Segment Elevation in 2 or more contiguous leads</p> Signup and view all the answers

    What is a STEMI mimic?

    <p>Pericarditis</p> Signup and view all the answers

    What is the Left Ventricular Hypertrophy Formula?

    <p>Count the small boxes of VI and V2, and V5 or V6</p> Signup and view all the answers

    What is a V4R?

    <p>A test for patients with ST segment elevation in 2 or more Inferior Leads</p> Signup and view all the answers

    What is the treatment for Right Ventricular Failure?

    <p>1 L IV/IO of Normal Saline</p> Signup and view all the answers

    What is not a STEMI Alert Disqualifier?

    <p>New onset Right Bundle Branch Block</p> Signup and view all the answers

    What should be done with patients who do not meet STEMI Alert Criteria?

    <p>Transport as a Cardiac Alert</p> Signup and view all the answers

    What is the definition of rapid atrial fibrillation and atrial flutter?

    <p>Ventricular rates &gt; 150 beats per minute</p> Signup and view all the answers

    What is the initial dose of CARDIZEM for atrial fibrillation and atrial flutter?

    <p>15-20 mg IV/IO</p> Signup and view all the answers

    What is a contraindication for CARDIZEM?

    <p>Hypotension (BP &lt; 90)</p> Signup and view all the answers

    What is the next step if CARDIZEM does not respond within 15 minutes?

    <p>Repeat the dose with 20-25 mg IV/IO</p> Signup and view all the answers

    What is the initial energy level for synchronized cardioversion in an unstable patient?

    <p>100j</p> Signup and view all the answers

    What is the treatment for CARDIZEM-induced hypotension?

    <p>Calcium chloride 500 mg to 1g IV/IO</p> Signup and view all the answers

    What is the definition of bradycardia?

    <p>Heartrate &lt; 50 beats per minute</p> Signup and view all the answers

    What is the dose of atropine for an unstable bradycardic patient?

    <p>0.5-1 mg IV/IO</p> Signup and view all the answers

    What should be evaluated carefully in unresponsive patients with LVAD?

    <p>A.E.I.O.U.-T.I.P.S. and H's &amp; T's</p> Signup and view all the answers

    What is the primary purpose of printing an ECG during administration?

    <p>To monitor the heart rate during supraventricular tachycardia</p> Signup and view all the answers

    Why should chest compressions be performed with caution in LVAD patients?

    <p>To prevent ventricular wall rupture</p> Signup and view all the answers

    What is the recommended positioning of hands during chest compressions in LVAD patients?

    <p>To the right of the sternum</p> Signup and view all the answers

    Which of the following patients is contraindicated for Adenosine therapy?

    <p>A patient with a history of second or third degree AV block without a functioning artificial pacemaker</p> Signup and view all the answers

    What is the recommended dosage of Cardizem for supraventricular tachycardia?

    <p>10 mg IV/IO over 2 minutes</p> Signup and view all the answers

    What should be checked before performing chest compressions in LVAD patients?

    <p>Blood glucose level</p> Signup and view all the answers

    What should be avoided when placing defibrillation pads on an LVAD patient?

    <p>Placing pads directly over the pump</p> Signup and view all the answers

    What is the contraindication for using Cardizem in supraventricular tachycardia?

    <p>Hypotension</p> Signup and view all the answers

    What is the recommended treatment for Cardizem-induced hypotension?

    <p>Administer Calcium Chloride</p> Signup and view all the answers

    What should be considered when transporting an LVAD patient?

    <p>The cables, controller, and batteries of the LVAD device</p> Signup and view all the answers

    What is the recommended transport destination for an LVAD patient?

    <p>The closest LVAD facility</p> Signup and view all the answers

    What is the dosage of Calcium Chloride for an adult patient with Cardizem-induced hypotension?

    <p>500 mg IV/IO in a 100 mL D5W Bag</p> Signup and view all the answers

    What is the recommended medication for sedation in an unstable patient with supraventricular tachycardia?

    <p>Versed</p> Signup and view all the answers

    Why should the LUCAS Compression Device be avoided in LVAD patients?

    <p>It is not compatible with the LVAD device</p> Signup and view all the answers

    In what situation should cardioversion be performed without delaying to establish IV access?

    <p>In an unstable patient with altered mental status or chest pain and hypotension</p> Signup and view all the answers

    Study Notes

    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

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    Description

    Identify the symptoms and criteria for a STEMI alert, including chest discomfort, syncope, and ECG readings. Learn to recognize the signs of a STEMI alert.

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