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