Harbor:Code STEMI - Revision history

SSchlesinger2: /* Procedure for Activating/Pre-Activating Code STEMI */

2019-12-02T14:08:47Z

Procedure for Activating/Pre-Activating Code STEMI

← Older revision		Revision as of 14:08, 2 December 2019
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	Code STEMI pages should include, at a minimum:		Code STEMI pages should include, at a minimum:
	* Patient age and sex		* Patient age and sex
			* Presenting complaint (e.g. Chest Pain, ROSC, ALOC, etc.)
	* Patient location and/or ETA		* Patient location and/or ETA
	* Phone number of Attending physician (full number including area code and Spectra extension)		* Phone number of Attending physician (full number including area code and Spectra extension)

SSchlesinger2: /* Pre-Hospital ActivationPatel, D. (2016, January). Base Hospital Physician Course [PDF]. Torrance: Harbor-UCLA. */

2019-12-02T14:07:52Z

Pre-Hospital ActivationPatel, D. (2016, January). Base Hospital Physician Course [PDF]. Torrance: Harbor-UCLA.

← Older revision		Revision as of 14:07, 2 December 2019
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	If the transferring hospital or reporting paramedic cannot or does not transmit the ECG, delay activation until the patient arrives and you have a chance to review the field or outside hospital ECG, or have performed one in our ED.<br>		If the transferring hospital or reporting paramedic cannot or does not transmit the ECG, delay activation until the patient arrives and you have a chance to review the field or outside hospital ECG, or have performed one in our ED.<br>

	The ~~process for pre-hospital activation is dependent on existing procedures outlined in the~~ Los Angeles County EMS Agency Prehospital Care Manual ~~and proceeds along~~ the ~~following pathway~~:		The Los Angeles County EMS Agency Prehospital Care Manual outlines the process for pre-hospital activation as follows:

	===Criteria for Contact/Transport to STEMI Receiving Center (SRC)===		===Criteria for Contact/Transport to STEMI Receiving Center (SRC)===

SSchlesinger2: /* Accepting STEMI Transfers from Outside Hosptials */

2019-12-02T14:05:44Z

Accepting STEMI Transfers from Outside Hosptials

← Older revision		Revision as of 14:05, 2 December 2019
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	Not all hospitals in our area are STEMI receiving centers; a hospital that is not a STEMI Center may call you in the emergency department to request transfer of a STEMI via 911 EMS response. This countywide protocol allows hospitals that are not STEMI centers to call 911 to emergently transfer a patient in their Emergency Department (not inpatients) to a STEMI Center for emergent cardiac catheterization. The process for accepting a STEMI 911 IFT is as follows:<br>		Not all hospitals in our area are STEMI receiving centers; a hospital that is not a STEMI Center may call you in the emergency department to request transfer of a STEMI via 911 EMS response. This countywide protocol allows hospitals that are not STEMI centers to call 911 to emergently transfer a patient in their Emergency Department (not inpatients) to a STEMI Center for emergent cardiac catheterization. The process for accepting a STEMI 911 IFT is as follows:<br>
	<br>		<br>
	1) Only Attending Base Hospital Physicians can accept a STEMI 911-IFT. <br>		* Only Attending Base Hospital Physicians can accept a STEMI 911-IFT. <br>
	2) Only STEMIs should be transferred by 911-IFT. This process should NOT be used for NSTEMIs or "concerning history"<br>		* Only STEMIs should be transferred by 911-IFT. This process should NOT be used for NSTEMIs or "concerning history"<br>
	3) These calls should be answered on the recorded line in the Radio Room at (310) 328-1800. If you receive a STEMI transfer call to your Spectra phone, please ask the caller to call the Radio Room and go there to answer. <br>		* These calls should be answered on the recorded line in the Radio Room at (310) 328-1800. If you receive a STEMI transfer call to your Spectra phone, please ask the caller to call the Radio Room and go there to answer. <br>
	4) The transferring hospital must transmit their ECG to you & there must be a Doc-to-Doc conversation to confirm that both of you see ST elevations on the ECG.<br>		* The transferring hospital must transmit their ECG to you & there must be a Doc-to-Doc conversation to confirm that both of you see ST elevations on the ECG.<br>
	5) If you don't see a STEMI, but the transferring physician reasonably believes that he/she does, please accept the patient and re-evaluate in our ED. <br>		* If you don't see a STEMI, but the transferring physician reasonably believes that he/she does, please accept the patient and re-evaluate in our ED. <br>
	6) If you do not see STEMI and the transferring physician reports concern for NSTEMI changes or troponin abnormalities, please advise them that we “would be happy to accept the patient for transfer via the Medical Alert Center; but at this time we are only supposed to accept STEMI 911-IFTs if they meet ECG criteria for emergent cardiac catheterization.” <br>		* If you do not see STEMI and the transferring physician reports concern for NSTEMI changes or troponin abnormalities, please advise them that we “would be happy to accept the patient for transfer via the Medical Alert Center; but at this time we are only supposed to accept STEMI 911-IFTs if they meet ECG criteria for emergent cardiac catheterization.” <br>
	<br>		<br>
	More information on STEMI patients and Interfacility Transfer of STEMI patients can be found on the Harbor-UCLA Intranet under DEM Policies and Procedures.		More information on STEMI patients and Interfacility Transfer of STEMI patients can be found on the Harbor-UCLA Intranet under DEM Policies and Procedures.

SSchlesinger2: /* Procedure for Activating/Pre-Activating Code STEMI */

2019-12-02T14:04:41Z

Procedure for Activating/Pre-Activating Code STEMI

← Older revision		Revision as of 14:04, 2 December 2019
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	* Phone number of Attending physician (full number including area code and Spectra extension)		* Phone number of Attending physician (full number including area code and Spectra extension)

	In addition, if an ECG has been performed in our ED, please ask the MICN/Clerk to fax the ECG to the "STEMI Fax" number while placing the page.		In addition, if an ECG has been performed in our ED, please ask the MICN/Clerk to fax the ECG to the "STEMI Fax" number while placing the page. Cardiology must review the ECG themselves to activate the Cath lab.

	A calendar with the Cardiology Attending on call, including phone and pager numbers, is posted		If the Cardiology Attending decides to cancel the Code STEMI, they should call the ED Attending to discuss. This decision should not be relayed through the Cardiology Fellow. A calendar with the Cardiology Attending on call, including phone and pager numbers, is posted monthly in the ED Radio Room to facilitate communication.

	==See Also==		==See Also==

SSchlesinger2: /* Procedure for Activating/Pre-Activating Code STEMI */

2019-12-02T13:45:23Z

Procedure for Activating/Pre-Activating Code STEMI

← Older revision		Revision as of 13:45, 2 December 2019
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	In addition, if an ECG has been performed in our ED, please ask the MICN/Clerk to fax the ECG to the "STEMI Fax" number while placing the page.		In addition, if an ECG has been performed in our ED, please ask the MICN/Clerk to fax the ECG to the "STEMI Fax" number while placing the page.

	A calendar of the ~~Cath Team~~ Cardiology Attending on call		A calendar with the Cardiology Attending on call, including phone and pager numbers, is posted

	==See Also==		==See Also==

SSchlesinger2: /* Procedure */

2019-12-02T13:21:32Z

Procedure

← Older revision		Revision as of 13:21, 2 December 2019
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	*Patient able to give informed consent		*Patient able to give informed consent

	==Procedure==		==Procedure for Activating/Pre-Activating Code STEMI==
	Code STEMI can be ~~activated via the auto-paging order in Orchid FirstNet titled "~~Code STEMI~~". Relevant~~ ECG~~'s should be submitted via~~ the STEMI ~~email (open in~~ the ~~radio room)~~.
			Code STEMI pages can be placed by anyone; but are usually placed by a Clerk or MICN.
			Code STEMI pages should include, at a minimum:
			* Patient age and sex
			* Patient location and/or ETA
			* Phone number of Attending physician (full number including area code and Spectra extension)

			In addition, if an ECG has been performed in our ED, please ask the MICN/Clerk to fax the ECG to the "STEMI Fax" number while placing the page.

			A calendar of the Cath Team Cardiology Attending on call

	==See Also==		==See Also==

SSchlesinger2: /* Background */

2019-12-02T13:13:57Z

Background

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	==Background==		==Background==
	Code STEMI is utilized to activate the cardiac catheterization ~~laboratory~~ for emergent revascularization in the setting of ST-elevation myocardial infarction.<br>		Code STEMI is utilized to activate the cardiac catheterization team for consideration of emergent revascularization in the setting of ST-elevation myocardial infarction.<br>
	<br>		<br>
	Harbor - UCLA is a STEMI Center, with 24/7 cardiac catheterization availability. STEMI activations are often called in from the field, and many patients are transferred from outside hospitals for STEMI treatment. <br>		Harbor - UCLA is a STEMI Center, with 24/7 cardiac catheterization availability. STEMI activations are often called in from the field, and many patients are transferred from outside hospitals for STEMI treatment. <br>

SSchlesinger2: /* Pre-Hospital ActivationPatel, D. (2016, January). Base Hospital Physician Course [PDF]. Torrance: Harbor-UCLA. */

2019-12-02T13:12:29Z

Pre-Hospital ActivationPatel, D. (2016, January). Base Hospital Physician Course [PDF]. Torrance: Harbor-UCLA.

← Older revision		Revision as of 13:12, 2 December 2019
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	==Pre-Hospital Activation<ref>Patel, D. (2016, January). Base Hospital Physician Course [PDF]. Torrance: Harbor-UCLA.</ref>==		==Pre-Hospital Activation<ref>Patel, D. (2016, January). Base Hospital Physician Course [PDF]. Torrance: Harbor-UCLA.</ref>==
	If a STEMI is reported in from the field or from another hospital (IFT) ~~ask~~ the ~~providers to transmit the ECG for review (if not already done). The~~ ECG should be printed by the MICN and brought to the Attending physician AND the physician should speak to the paramedics or transferring physician to get their clinical assessment. ~~Per the request of our colleagues in Interventional Cardiology, if~~ you agree that the transmitted ECG and clinical history is consistent with STEMI, ~~you should~~ page out the STEMI as soon as possible. DO NOT wait for patient to arrive before placing the page, regardless of time of day. The Interventional Cardiologist on-call will review the ECG ~~as well~~ and cancel the STEMI activation if they disagree. ~~However, if~~ the transferring hospital or reporting paramedic cannot or does not transmit the ECG, ~~you should~~ delay activation until the patient arrives ~~in the emergency department~~ and you have a chance to review the field or outside hospital ECG, or have performed one in our ~~emergency department~~.<br>		If a STEMI is reported in from the field or from another hospital (911-IFT) the prehospital ECG should be printed by the MICN and brought to the Attending physician AND the physician should speak to the paramedics or transferring physician to get their clinical assessment. <br><br>

			If you agree that the transmitted ECG and clinical history are consistent with STEMI (see LA County Criteria for Pre-hospital Activation" (below), page out the STEMI as soon as possible. DO NOT wait for patient to arrive before placing the page, regardless of time of day. The Interventional Cardiologist on-call will review the ECG and cancel the STEMI activation if they disagree. <br><br>

			If the transferring hospital or reporting paramedic cannot or does not transmit the ECG, delay activation until the patient arrives and you have a chance to review the field or outside hospital ECG, or have performed one in our ED.<br>

	The process for pre-hospital activation is dependent on existing procedures outlined in the Los Angeles County EMS Agency Prehospital Care Manual and proceeds along the following pathway:		The process for pre-hospital activation is dependent on existing procedures outlined in the Los Angeles County EMS Agency Prehospital Care Manual and proceeds along the following pathway:
	~~===Pre-Hospital 12-lead ECG===~~
	~~A pre-hospital 12-lead ECG is obtained in the following settings:~~		===Criteria for Contact/Transport to STEMI Receiving Center (SRC)===
	*Chief complaint of chest pain		*Good-quality 12-lead ECG with >1mm ST-segment elevation in 2 or more contiguous leads, AND
	*Alternative chief complaint suggestive of an acute cardiac event		Computer analysis indicates ACUTE MI*or manufacturer equivalent, OR
	*Relevant and significant medical history which increases the likelihood of an acute cardiac event		*Paramedic concern for evolving ECG changes (i.e. hyperacute T waves in high risk patient)
	*New-onset dysrhythmia
	*ROSC		===Los Angeles County Criteria for Pre-hospital Activation of Code STEMI (abbreviated)===
	===Criteria for ~~contact~~/~~transmission~~ to STEMI Receiving Center (SRC)===		*Paramedic confident in STEMI impression
	*Good-quality 12-lead ECG with >1mm ST-segment elevation in ~~greater than~~ 2 contiguous leads.
	Computer analysis indicates ACUTE MI*or manufacturer equivalent.
	===Criteria for ~~pre~~-hospital ~~activation~~ of Code STEMI===
	*ED physician agrees with STEMI impression		*ED physician agrees with STEMI impression
	*Age 30-90		*Age 30-90
	*Pain less than 12 hours		*Pain less than 12 hours
	*~~Greater than 2mm S-T elevation in 2 or more contiguous leads~~		*Narrow QRS and Heart Rate <120
	*QRS ~~less than 0.12~~		*Patient able to give informed consent
	*Heart Rate ~~less than~~ 120
	*~~No paced rhythm~~
	*No DNR
	*Able to give informed consent
	*Not intubated
	*Paramedic confident in STEMI impression

	If the requirements for pre-hospital activation are not met, the patient should undergo expedited evaluation upon arrival in the emergency department to determine appropriateness for Code STEMI activation.

	==Procedure==		==Procedure==

SSchlesinger2: /* Accepting STEMI Transfers from Outside Hosptials */

2019-12-02T13:02:27Z

Accepting STEMI Transfers from Outside Hosptials

← Older revision		Revision as of 13:02, 2 December 2019
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	==Accepting STEMI Transfers from Outside Hosptials==		==Accepting STEMI Transfers from Outside Hosptials==

	Not all hospitals in our area are STEMI receiving centers; a hospital that is not a STEMI Center may call you in the emergency department to request transfer of a STEMI via ~~9-1-1~~ EMS ~~ambulance~~. This countywide protocol allows hospitals that are not STEMI centers to call 911 to emergently transfer a patient in their Emergency Department (not inpatients) to a STEMI Center for emergent cardiac catheterization. The process for accepting a STEMI 911 IFT is as follows:<br>		Not all hospitals in our area are STEMI receiving centers; a hospital that is not a STEMI Center may call you in the emergency department to request transfer of a STEMI via 911 EMS response. This countywide protocol allows hospitals that are not STEMI centers to call 911 to emergently transfer a patient in their Emergency Department (not inpatients) to a STEMI Center for emergent cardiac catheterization. The process for accepting a STEMI 911 IFT is as follows:<br>
			<br>
	1) Only Attending Base Hospital Physicians can accept a STEMI 911-IFT. <br>		1) Only Attending Base Hospital Physicians can accept a STEMI 911-IFT. <br>
	2) Only STEMIs should be transferred by 911-IFT. This process should NOT be used for NSTEMIs or "concerning history"<br>		2) Only STEMIs should be transferred by 911-IFT. This process should NOT be used for NSTEMIs or "concerning history"<br>

SSchlesinger2: /* Pre-Hospital ActivationPatel, D. (2016, January). Base Hospital Physician Course [PDF]. Torrance: Harbor-UCLA. */

2019-12-02T12:33:39Z

Pre-Hospital ActivationPatel, D. (2016, January). Base Hospital Physician Course [PDF]. Torrance: Harbor-UCLA.

← Older revision		Revision as of 12:33, 2 December 2019
Line 23:		Line 23:

	==Pre-Hospital Activation<ref>Patel, D. (2016, January). Base Hospital Physician Course [PDF]. Torrance: Harbor-UCLA.</ref>==		==Pre-Hospital Activation<ref>Patel, D. (2016, January). Base Hospital Physician Course [PDF]. Torrance: Harbor-UCLA.</ref>==
			If a STEMI is reported in from the field or from another hospital (IFT) ask the providers to transmit the ECG for review (if not already done). The ECG should be printed by the MICN and brought to the Attending physician AND the physician should speak to the paramedics or transferring physician to get their clinical assessment. Per the request of our colleagues in Interventional Cardiology, if you agree that the transmitted ECG and clinical history is consistent with STEMI, you should page out the STEMI as soon as possible. DO NOT wait for patient to arrive before placing the page, regardless of time of day. The Interventional Cardiologist on-call will review the ECG as well and cancel the STEMI activation if they disagree. However, if the transferring hospital or reporting paramedic cannot or does not transmit the ECG, you should delay activation until the patient arrives in the emergency department and you have a chance to review the field or outside hospital ECG, or have performed one in our emergency department.<br>

	The process for pre-hospital activation is dependent on existing procedures outlined in the Los Angeles County EMS Agency Prehospital Care Manual and proceeds along the following pathway:		The process for pre-hospital activation is dependent on existing procedures outlined in the Los Angeles County EMS Agency Prehospital Care Manual and proceeds along the following pathway:
	===Pre-Hospital 12-lead ECG===		===Pre-Hospital 12-lead ECG===