1 STEMI PROTOCOL UNION HOSPITAL EMERGENCY DEPT.

2 Presentation of Patient Patient presenting to ER with acute chest pain suspicious of cardiac origin will have chest pain orders initiated upon arrival. Communicate with Sec. to order Labs/Xray. Patient presenting to ER with acute chest pain suspicious of cardiac origin will have chest pain orders initiated upon arrival. Communicate with Sec. to order Labs/Xray.

3 ER ECA/Charge Nurse Role Greeter will notify Via Vocera that STAT EKG needs done. This must be done when patient is being taken to room to ensure EKG completed in 10 minutes. Greeter will notify Via Vocera that STAT EKG needs done. This must be done when patient is being taken to room to ensure EKG completed in 10 minutes. ER will only be responsible for the EKG. Once EKG performed, it is to be immediately handed delivered to the ERMD for interpretation. ER will only be responsible for the EKG. Once EKG performed, it is to be immediately handed delivered to the ERMD for interpretation.

4 Care of Patient Triaging the patient and getting their medical information takes second priority to getting EKG, placing the patient on Oxygen and application of cardiac monitor, initiation of IV and having blood work drawn. Triaging the patient and getting their medical information takes second priority to getting EKG, placing the patient on Oxygen and application of cardiac monitor, initiation of IV and having blood work drawn. If EKG reveals ST Elevated Myocardial Infarction(STEMI) the ERMD will initiate the STEMI standard order set. If EKG reveals ST Elevated Myocardial Infarction(STEMI) the ERMD will initiate the STEMI standard order set.

5 STEMI Routine Orders

6 Care of STEMI Patient Upon notification of STEMI routine orders nurse will ensure that routine orders had been initiated. Upon notification of STEMI routine orders nurse will ensure that routine orders had been initiated. Administer medications according to routine order sheet. Utilize STEMI Drug Box. Remove under STEMI drug box in Pyxis. Integrillin kept in Pyxis. Fax Drug sheet to pharmacy to show STEMI Drug box used and needs refilled. Administer medications according to routine order sheet. Utilize STEMI Drug Box. Remove under STEMI drug box in Pyxis. Integrillin kept in Pyxis. Fax Drug sheet to pharmacy to show STEMI Drug box used and needs refilled. Obtain consent for “Left Cardiac Catheterization with Possible Percutaneous Coronary Intervention” Obtain consent for “Left Cardiac Catheterization with Possible Percutaneous Coronary Intervention”

7 Care of STEMI Patient Cont’d. Ensure that patient completely undressed. Ensure that patient completely undressed. If time permits, clip hair in 8 inch circle on both sides of groin. If time permits, clip hair in 8 inch circle on both sides of groin. Assist with transfer of patient to Cath Lab upon their arrival. Assist with transfer of patient to Cath Lab upon their arrival. Send original chart with patient including consent and STEMI Flowsheet/Timer/Clipboard Send original chart with patient including consent and STEMI Flowsheet/Timer/Clipboard

8 Role of ER Secretary Upon notification from greeter of need for EKG ER ECA or Charge Nurse will be notified of need for EKG, if they are unable to perform page CVT by putting room # and chest pain in pager. To ensure that patient receives EKG within 10 minutes of arrival. Upon notification from greeter of need for EKG ER ECA or Charge Nurse will be notified of need for EKG, if they are unable to perform page CVT by putting room # and chest pain in pager. To ensure that patient receives EKG within 10 minutes of arrival. If coming by EMS 12 Lead EKG will be transmitted via Lifenet Alert. If coming by EMS 12 Lead EKG will be transmitted via Lifenet Alert. ERMD will notify secretary to page cardiologist per STEMI paging protocol, picked by: Patient’s private cardiologist or his on call coverage, PCP usual preference, or Interventional Cardiologist on call. ERMD will notify secretary to page cardiologist per STEMI paging protocol, picked by: Patient’s private cardiologist or his on call coverage, PCP usual preference, or Interventional Cardiologist on call.

9 Role of ER SEC Cont’d. ER Sec will log times called and received. The cardiologist will be called every 5 minutes. If no answer in 10 minutes, go to next one on list, i.e.Interventional Cardiologist on call. ER Sec will log times called and received. The cardiologist will be called every 5 minutes. If no answer in 10 minutes, go to next one on list, i.e.Interventional Cardiologist on call. The ER sec will fax EKG if requested. The ER sec will fax EKG if requested. If 12 Lead via Lifenet, EKG will be forwarded to Cath Lab. If 12 Lead via Lifenet, EKG will be forwarded to Cath Lab. The ER sec will simultaneously page the Cath lab per STEMI Paging Protocol. The ER sec will simultaneously page the Cath lab per STEMI Paging Protocol. Cath lab will return call to STEMI phone( ) Cath lab will return call to STEMI phone( ) STEMI Flowsheet/Timer/Clipboard will be sent to cath lab upon patient transfer. STEMI Flowsheet/Timer/Clipboard will be sent to cath lab upon patient transfer. After 6pm, notify house supervisor and security to open Cath Lab After 6pm, notify house supervisor and security to open Cath Lab

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