1. Challenging Case Presentations From South Texas Methodist Hospital
REGIONAL SYSTEMS OF CARE DEMONSTRATION PROJECT: MISSION: LIFELINE™ STEMI SYSTEMS ACCELERATOR

2. Case 1
65 y/o female with sudden onset of sub-sternal chest pain at 11PM
EMS called. On arrival offers to transport to non-PCI capable facility 30 minutes away.
Husband declines and drives patient to free standing ED
On arrival 11:36 pt ECG c/w acute inferior STEMI
ED physician notifies cardio-hospitalist, transmits ECG, while the patient is being loaded for transport

3. ECG on arrival to ED

4. Hospital Course
Pt arrived to PCI capable facility at 12:20 and taken directly
to cath lab
Initial balloon inflation at 12:38
D2B from ED 62 minutes
Total ischemic time 98 minutes

5. Cardiac Cath

6. Cardiac Cath

7. Cardiac Cath

8. Points of discussion
Should EMS have even offered to go to a non- PCI capable facility?
Should lytics have been given prior to transport?
Would an EMS on site ECG changed the course or even expedited the care?