STEMI

It is important to remember that an ECG is not 100% sensitive for coronary occlusion and that the absence of STE does not rule out an MI - Daniel Kreider MD

STEMI

image by: Heart & Vascular Institute at Titus

HWN Suggests

The Widowmaker: STEMI management in the ED

Goals of immediate care in ED of STEMI patients:

  • relief of pain
  • assess hemodynamic status
  • initiate reperfusion therapy (PCI vs fibrinolytics)
  • give antithrombotic therapy

Management: Initial pharmacologic management in the emergency department can vary by institution so we recommend consulting with your interventional cardiologist to get on board with their initial treatment regimen. However, it is good to become familiar with all the different possible treatments.

Oxygen: No longer recommended if O2 saturation is >90% as some studies showed harm with larger infarcts…

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Resources

 The Widowmaker: STEMI management in the ED

Management: Initial pharmacologic management in the emergency department can vary by institution so we recommend consulting with your interventional cardiologist to get on board with their initial treatment regimen. However, it is good to become familiar with all the different possible treatments.

HEART Score

Use in patients ≥21 years old presenting with symptoms suggestive of ACS. Do not use if new ST-segment elevation ≥1 mm or other new EKG changes, hypotension, life expectancy less than 1 year, or noncardiac medical/surgical/psychiatric illness determined by the provider to require admission.

TIMI Risk Score

Estimates mortality in patients with STEMI.

CDEM

The most serious cause of ST elevations on ECG is a ST elevation MI, however there are other possible etiologies. As usual always consider the “worst first”. In borderline or atypical cases remember that timely diagnosis of STEMI is imperative versus diagnosing a benign condition such as early repolarization.

Evaluation and Management of ST-Segment Elevation Myocardial Infarction in the Emergency Department

This issue reviews the current literature on emergency department management of STEMI, including recognition of more subtle diagnoses on electrocardiogram, identification of STEMI mimics, an update on treatment therapies, and strategies to achieve more effective management of STEMI across gender and age groups.

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