2-8 ACUTE ST ELEVATION MYOCARDIAL INFARCTION

Note: This protocol assumes that the patient has already had a 12 lead EKG diagnostic of an Acute ST Elevation MI. Patients with suspected MI should be treated via the Adult Chest Pain protocol until 12 Lead EKG done and evaluated.

EKG findings diagnostic of ST Elevation MI are ST elevations of > 1mm in 2 or more contiguous leads or any patient with a Left Bundle Branch Block and symptoms consistent with cardiac chest pain.

Time from onset of symptoms to reperfusion of the myocardium is the key determinant of outcome. Every effort should be made to minimize scene time, within the constraints of patient safety. Goal of scene time less than 20 minutes

Intermediate - Perform/Confirm All Above Interventions

1. Prepare for expedited transfer of the patient.
2. Establish IV en route to the hospital.
3. Fax 12 Lead EKG to hospital if technology available.
4. Consult Medical Control and notify of incoming patient with a “Code STEMI” for consideration of cath lab activation and resource preparation. Communicate patient name and date of birth to receiving facility if using cell phone.
5. Confirm Aspirin administration.
6. Administer nitroglycerin
   1. Unless any of the following are true: (If true, do not administer nitroglycerin):
      1. This is an inferior or posterior STEMI
      2. SBP < 100 mmHg
      3. Patient has already received 3 doses of NTG
      4. Patient has recently taken erectile dysfunction drugs such as Viagra, Cialis, or Levitra
   2. Place or spray under tongue
   3. Reassess vital signs for hypotension after each intervention and if the SBP remains > 100 mm Hg, may repeat every 3-5 minutes to a total of 3 doses.
7. Evaluate rhythm strip and treat any identified dysrhythmia via appropriate ACLS protocol.
8. Administer 50 mcg of fentanyl (Sublimaze) IV/IO if patient has continued pain despite nitroglycerin and aspirin
   1. Reassess vital signs after each dose.
   2. May repeat every 3- 5 minutes to a total dose of 150 mcg of fentanyl (Sublimaze), provided SBP remains > 100 mm Hg before each dose.
9. Consult medical control regarding continued nitroglycerin administration

Paramedic - Perform/Confirm All Above Interventions

CONTACT MEDICAL CONTROL for additional orders