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Learning Objectives Upon completion of this lecture, nursing staff will be able to::

Learning Objectives Upon completion of this lecture, nursing staff will be able to: Recognize physical signs and symptoms of patient’s suffering from a STEMI. Identify a STEMI on an EKG. Implement CODE STEMI in a timely manner. Recall the appropriate personnel to notify for a STEMI occurring on the unit. Complete appropriate nursing responsibilities prior to Cath Lab arrival (blood draws, IV access, medications). Prepare patient to be on Cath Lab table within a 90 minute time frame for Percutaneous Coronary Intervention (PCI).

Goals:

Goals Learn the CODE STEMI algorithm flowchart. Mirror the inpatient CODE STEMI to directly reflect that of the ED’s CODE STEMI. Reduce Door-to-Balloon time to under 90 minutes. Increase STEMI annual survival rate.

What is a STEMI?:

What is a STEMI? This Photo by Unknown Author is licensed under CC BY

What is a STEMI?:

What is a STEMI? Signs and symptoms of cardiac ischemia present. 100% occlusion of a coronary artery. ST-Elevation is present on electrocardiogram. Cardiac biomarkers indicative of myocardial ischemia/necrosis are elevated.

Signs and Symptoms of Myocardial Infarct:

Signs and Symptoms of Myocardial Infarct Chest pain or pressure on left side Neck or Jaw pain Shoulder or arm pain Diaphoresis (sweating) Fatigue Nausea and vomiting Tachycardia Shortness of breath with exertion

Initiate EKG:

Initiate EKG Notify physician of patient’s symptoms and obtain order for EKG. The EKG should be interpreted by physician within 10 minutes. TIME IS MUSCLE!!!

What if ST elevation is identified on EKG???:

What if ST elevation is identified on EKG??? ACTIVATE CODE STEMI!!!!

Notify the Appropriate Parties:

Notify the Appropriate Parties Call 3111: CODE STEMI phone line (contacts ED charge nurse, Cath Lab staff, ED Attending) Notify House Supervisor If patient is “agreeable,” proceed with protocol

Duties of Nursing Staff:

Duties of Nursing Staff Follow the appropriate Acute Coronary Syndrome (ACS) protocol: M.O.N.A.= M orphine. O xygen. N itroglycerin. A spirin. Recent set of vital signs STAT labs: Chest pain panel, Troponins, CK, CK-MB IV access Groin prepped Pulses marked

Door to Balloon:

Door to Balloon Must be done in 120 minute time frame. 90 minutes or less is preferred. If unable to happen in 120 minutes, clot busting drugs will be administered within 30 minutes; tissue plasminogen activator ( tPA )

Case Study:

Case Study A 62-year old woman was admitted to the medical-surgical unit 2 days ago. She is being treated for shortness of breath. She has a 35 pack-year smoking history and also a history of hypertension, COPD, and GERD. During rounds, she notifies you that she has been having chest pain for the last 30 minutes. She complains that the pain is beginning to radiate down her left arm. You perform an assessment and note her respirations are becoming more labored and she is diaphoretic. Break into small groups of four and write out an action plan for the appropriate next steps to care for this patient.

References:

References Ahmed, D. (2015, January 25). A Guide to STEMI (ST-elevation Myocardial Infarction) Heart Attacks . Retrieved from MY HEART.NET: Take control of your Health: https://myheart.net/articles/stemi/ American Heart Association. (2015). CPR and ECC Guidelines; Part 9: Acute Coronary Syndromes. Retrieved from CPR and First Aid: Emergency Cardiovascular Care: https://eccguidelines.heart.org/index.php/circulation/cpr-ecc-guidelines-2/part-9-acute-coronary-syndromes/ American Heart Association. (2016, June 30). Diagnosing a Heart Attack. Retrieved April 2019, from https://www.heart.org/en/health-topics/heart- attack/diagnosing-a-heart-attack Glenn N. Levine, M., Xuming Dai, M. P., Henry, T. D., & al, e. (2018, February). In-Hospital ST-Segment Elevation Myocardial Infarction: Improving Diagnosis, Triage, and Treatment. JAMA Cardiol . Mayo Clinic Staff. (2019, April 6). Myocardial Ischemia. Retrieved from Mayo Clinic: https://www.mayoclinic.org/diseases-conditions/myocardial- ischemia/symptoms-causes/syc-20375417 U.S. Department of Health and Human Services. (n.d.). Heart Attack. Retrieved April 2019, from National Heart, Lung, and Blood Institute: https://www.nhlbi.nih.gov/health-topics/heart-attack

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