Code STEMI Developed by Lori Baker, RN, BSN
Where Do They Come From? • Medic Unit in the field • They will transmit an EKG • Walk-in through triage • In-house patient
• ED physician becomes aware of the patient with STEMI • Either through transmitted EKG or seeing the patient • ED physician makes the decision to call a CODE STEMI • Note: any physician responding to a Rapid Response can call a Code STEMI • In the ED, our doc will let the charge nurse know; the charge nurse or unit secretary will call the Control Center using 3 -1911 to activate the page
Code STEMI is called…Now What? • Cardiologist on call is paged • The cardiologist will contact the ED physician • If no phone call is received within 5 minutes, the ED Physician will call the cell phone of the Cardiologist on call for STEMI
Get the Gang Together! • The paging system alerts the following: • Cath lab staff • Hospitalists • Lab • Radiology • Nursing supervisor • Bed coordinator • ED Nurse Manager • ICU Nurse Manager • Admissions Coordinator
And They’re Off!!! • Hospitalist reports to ED to assist in transporting patient to cath lab • Nursing supervisor identifies room for inpatient admission • The first cath lab member on site comes to ED to collect patient and expedite transfer to cath lab • Remaining cath lab staff members prep the procedure room • Patient is transported to cath lab with hospitalist or cardiologist and cath lab staff
Role of ED Staff • Educate patient and family/support system in a calm and orderly manner • Several members of the ED team are needed to work quickly and efficiently • Team leader should be the primary nurse and/or ED physician • Someone needs to assign roles to cover all of the following in a simultaneous manner…
• Complete assessment and completion of triage questions must be done quickly – this patient is still an ED patient • Establish 2 large bore IV’s – preferably antecubital • Repeat EKG as directed by physician • Retrieve clot box • At the very least we will give baby ASA from this (also NTG – they may need Morphine from the Omnicell) • Attach to Zoll monitor (should already be on the bedside monitor), NIBP, Pulse ox
• PLACE ON SUPPLEMENTAL OXYGEN VIA NASAL CANNULA REGARDLESS OF THE PULSE OX READING – the heart needs extra oxygen • PCXR should be done prior to going to cath lab • Labs need to be drawn – preferably with an IV start – if not phlebotomist is part of the team and will draw
• Door to balloon time goal is 90 minutes or less • This means, from the time the patient comes through the ED doors to the time the cardiac cath is inserted into the heart and the balloon is inflated should be no more than 90 minutes – just getting them TO the cath lab is not enough – time is still ticking!!!
The Goal… • Limit the extent of Myocardial Infarction • Salvage jeopardized ischemic myocardium • Recanulize infarct-related arteries
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