(精选)STEMI Primer 101 From Presentation to Cath Lab教学课件.pptVIP

Transfer of Patients With STEMI to a PCI-Capable Hospital for Coronary Angiography After Fibrinolytic Therapy Reperfusion at a Non–PCI-Capable Hospital Rescue PCI If evidence of cardiogenic shock, severe heart failure hemodynamically compromising ventricular arrhythmias. If fibriolysis has failed Evaluate 90 minutes for a 50% ST resolution in lead with greatest elevation SACMC Standards EMS SENDS EKG TO ER MD FROM FIELD Scene time 15 min for STEMI. ER MD MAKES DX and ACTIVATES CATH LAB TEAM One phone call activation ER PRESENTATION-EKG 5 MIN ER MED BOX DIRECT ADMIT TO CATH LAB SACMC SACMC average DBT 54 min Five years of DBT 90 min Local EMS should generally be used if available and 30 minute transportation time to destination hospital Whenever possible, helipad adjacent to ED Helicopter capable of transporting patients on 10 minute notice 24/7. When not available alternate transport options identified. Immediately activate helicopter transport during initial communication between referring hospital ED and receiving hospital regarding need for reperfusion Establish a system whereby all patient transfers of any type can be specified as time critical within one hour versus diversion possible Helicopter Transfer Onsite Helipad: Availability of Transport Ground/Air Transfer: Enhance First Responders Early activation of Air When Helicopter Not Available: Identify Plan B: Who is next Referral team activates: Continuing Medical Implementation …...bridging the care gap Early Mortality After AMI Mortality at 25 - 30 Days GISSI-1 Pre-CCU CCU b-Block GUSTO ISIS-2 GUSTO-3 ASSENT-2 SK SK+ASA tPA tPA rPA tPA TNK Medications ASA 325 mg po chewed Ticagrelor (Brilinta) 180 mg Alternative-Clopidogrel (Plavix) 600 mg Alternative-Prasugrel (Effient) 60 mg Heparin 5000 unit IV Atorvastatin 80 mg Primary endpoint: CV death, MI or stroke 0 1 2 3 4 5 6 7 8 9 1