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Patient care treatment protocol

Bonner County EMS System Patient Care Treatment Guidelines-Cardiac Emergencies Acute Coronary Syndromes: STEMI Evaluation Tool-5011 STEMI EVALUATION TOOL
Evaluation tool for patients intended for direct Percutaneous Intervention (PCI)
Date_______________ PCR Run #____________________ Patient name:___________________________DOB/age:___________Weight:________ Symptom onset time:_____am/pm Time of EMS on scene:_______am/pm Scene time:_____________minutes KMCArrival time:_______ am /pm EMS contact to cath lab arrival:______min. Verify STEMI criteria (initial each consideration):
A. Ongoing signs and symptoms of ischemia______________
B. EKG demonstrates at least 2mm of ST elevation in two contiguous leads and/or ______
a left BBB and/or________ a paced rhythm _________last three digits of EKG identification #____ C. Pt. must not indicate possible CVA via stroke screening________
Medications: Paramedic administering Medications:______________
A. ASPIRIN 81 mg, 4 tablets po or chewed (ED/ EMS)
Time given:____________________ Total dose:__________
B. NITROGLYCERIN spray 0.4 mg, 1 spray SL for chest pain, may repeat x 3 (ED/EMS)
Time given:____________________ Total dose:__________ A. MORPHINE 2mg IV Q 5 minutes up to 20 mg, or FENTANYL 25-100 mcg q 5 minutes up to 300 mcg Times given:________Total dose:__________ (ED/EMS) or Times given:_______________Total dose:__________ (ED/EMS)
B. NITROGLYCERIN drip at 5-10 mcg/min (titrate to SBP>100 and Patient’s chest pain) (started in ED/ or by EMS)
Time started:____________ infusion rate:_________mcg/min Time____________any change in infusion rate________mcg/min
C. METOPROLOL TARTRATE 5mg IV (may repeat to total of 3 doses as long as SBP>110 and HR>70) (ED/EMS)
Times given:_______________________total dose :__________mg
D. HEPARIN 50 U/kg, (maximal total of 5000 units) (ED/EMS)
Time given:_____________total dose:___________units
HOLD heparin for any history or evidence of abnormal bleeding, coumadin Rx, major trauma, surgery or stroke in last 6 weeks, SBP >200 or DBP >110
POSSIBLE MEDICAL CONTROL/CARDIOLOGY ORDERS

E. CLOPIDIGREL (PLAVIX) 300 mg PO or 600 mg PO (circle dose) (ED/EMS)
Time:_____________ total dose :__________mg
Hold if patient is on coumadin, or known sensitivity to Plavix (Clopidogrel) and/or Effient (Prasugrel), history of abnormal bleeding, recent stroke, hemorrhagic CV.
F. Eptifibatide (Integrilin) 180 mcg/kg bolus x 2, 10 minutes apart, and 2mcg/kg/min drip (Administer via 2nd IV)
Times given:____________________total bolus_________________infusion rate:___________________ (started in ED/ or by EMS)

HOLD
Eptifibatide (Integrilin) for:
Any history or evidence of abnormal bleeding in last month, SBP > 200 or DBP>110, recent (within 6 weeks CVA) or ANY history of hemorrhagic CVA (ever)
Recent major trauma or surgery (within last 6 weeks), Coumadin/warfarin Rx, patient is on renal dialysis or in renal failure.
See attached Eptifibatide dosing table including renal dosing chart (1 mcg/kg/min).
_______________________________________________________________________________________________________________________________________
BCEMS Medical Director
Effective:
Bonner County EMS System Patient Care Treatment Guidelines-Cardiac Emergencies Acute Coronary Syndromes: STEMI Evaluation Tool-5011 _______________________________________________________________________________________________________________________________________ BCEMS Medical Director Effective:

Source: http://www.bonnerems.com/wp-content/uploads/PDF%20and%20documents/Clinical%20Practice%20Guidelines/9-01-2011Changes.pdf

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MIFEPREX® Label MIFEPREX® (mifepristone) Tablets, 200 mg For Oral Administration Only DOSAGE AND ADMINISTRATION Treatment with Mifeprex and misoprostol for the termination of pregnancy requires three office visits by the patient. Mifeprex should be prescribed only by physicians who have read and understood the prescribing information. Mifeprex may be administered only in a cli

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