INDEX

STEMI (Code MI)

Table of Contents:

• Questionable STEMI

• Pre-hospital STEMI

• UED STEMI Protocol

• HED STEMI Protocol

• GED STEMI Protocol

Cross References:

• None

• Some cases may have borderline EKGs (e.g. questionable elevations, isolated aVRs) or questionable stories (e.g. no anginal symptoms with what appears to be a STEMI).

• Do not simply call a "Code MI" on all questionable cases.

• Page the interventional cardiology attending and discuss the case.

• While a digital copy of the EKG is automatically uploaded to the patient's chart, the EKG should also be emailed via the printer/fax machine to "cardoncall@uabmc.edu" so the cardiologist can review it without needing to login to Cerner.

• If you are shown a pre-hospital EKG that is an obvious STEMI, proceed with activating the Code MI process.

• If you are shown a pre-hospital EKG that is questionable, proceed with the questionable STEMI process above.

• When able, document your review and decision making for pre-hospital EKGs in the patient’s PowerNote after they arrive.

• Page “Code MI (or STEMI)” through the operator. If you have trouble getting through, there is a specific Code MI direct line at 4-2395.

• Activate the "UED STEMI" PowerPlan, which contains most of the STEMI/ACS-specific medications and infusions.

  • This PowerPlan can be used at UED, HED and GED.

  • Typically, the following medications are given:

    • ASA 324 mg

    • Heparin 4000 unit IV bolus

    • Ticagrelor 180 mg

• The cardiology fellow may come down to assess the patient as plans are made to take the patient upstairs to the cath lab.

• Page "Code MI" through the operator.

• HED charge nurse calls Lifeguard to transport to UAB Cath Lab.

• Critical Care Transport (CCT) coordinator will get "Code MI" page as well and should be available if Lifeguard is not.

• RN will keep time and make MD aware when 15 minutes has elapsed.

• If transport team is not present at minute 20, nurse will make the MD aware and have Tenecteplase at the bedside.

• Nurse should NOT mix the Tenecteplase unless MD gives the order.

Two key phone calls:

1. Page "Code MI" through the operator.

2. Call Bed Accommodations/CPF to ensure fast-track acceptance to UAB.

KEYWORDS: code MI, STEMI, heart attack, AMI