Post your STEMI

[CBEMT]

Had this late last year. 61yom - could see he was having an MI as soon as we walked through the door, no need for monitor! Classic signs and symptoms right down to the "sense of impending doom".

Oxygen, 300mg Aspirin, 2mg Buccal GTN, IV access, 10mg Morphine, 5000u Heparin and 9000u Tenectaplase then transferred to local Coronary Care Unit.

Call to needle time of 12 minutes!

Holy @#$%, you got all that done in 12 minutes???

[theotherphil]

Holy @#$%, you got all that done in 12 minutes???

It took us 5 minutes to get there so all the assessment and initial treatment was done in 7 minutes. My partner put on the O2 and got all the obs...12 lead, bp, SPO2, HR, blood sugars and gave the aspirin and GTN while I took the history, gained IV access, assessed all the obs and history to determine suitability for pre-hospital thrombolysis and drew up and administered the medications. The patient was in the Coronary Care unit in under 20 minutes from placing the call.

We were shocked ourselves when looking at the times afterwards but everything went so smoothly and we worked well together.

[Medic26]

This is actually one of our regular patients who kind of took me off guard.

[fiznat]

^^ I'm not seeing the STEMI in that one, especially in the setting of LBBB.... Maybe some P and T changes (a dialysis patient, maybe?), but no big MI.. Maybe I'm missing something...? :scratch:

[EMS49393]

47 year old male, found on the bed. States he was mowing the lawn when he developed severe substernal chest pain. No radiation of pain, mild shortness of breath. Wife called 911 less than 5 minutes from onset of symptoms. Our arrival less than 6 minutes from call.

12-lead performed within 2 minutes of patient contact, rapidly moved to ambulance, thanks to the fire department cooperating. Scene time less than 8 minutes. (They're always in the back room of the house.) Less than 10 minute transport to ER. Treatment included: 18 g IV x2, ASA 162 mg PO, NTG x2, high flow O2, Morphine 10 mg IVP, Zofran 4 mg IVP, NTG drip established and titrated to 50 mcg/min by arrival to ER. Unable to transmit ECG, however called ER en route with patient report. Onset to cath lab, less than 40 minutes.

The patient's wife caught us outside the ER a day or so following this call. She told us her husband had gotten 3 stents during cath and would be coming home in a few days.

Everything came together for this patient. Quick access by his wife undoubtedly saved his life. The fire department were invaluable removing this man from his dwelling. I happened to be working for a hospital based EMS service and transported to my hospital. The ER staff know all of us, and trust all of us. This call will always be the best call I'll ever run.

[fiznat]

Excuse my language but holy shit!!! :shock:

[Asysin2leads]

This is the point in the call where I self-administer the nitro and the aspirin.

[Medic26]

^^ I'm not seeing the STEMI in that one, especially in the setting of LBBB.... Maybe some P and T changes (a dialysis patient, maybe?), but no big MI.. Maybe I'm missing something...? :scratch:

Well, yes that was my initial impression too but after the ER doc called a STEMI and she went to the cath lab I had him explain to me what he saw. When I saw the 12-lead I figured she had something going on but I wasn't calling the doc.....still treated appropriately.

He siad:

Elevation in AVL, V-3 and he says V-4 too but how can you tell.

Depression in II, III, AVF

He also said that V-1 and V-2 were elevated one mm but that would be a stretch.

YUP.....I walked away scratching my head too. So far I've only had one medic that I've showed it too say that he would call it a STEMI. I suppose that is why the MD's make the big bucks. :wink:

[hammerpcp]

47 year old male, found on the bed. States he was mowing the lawn when he developed severe substernal chest pain. No radiation of pain, mild shortness of breath. Wife called 911 less than 5 minutes from onset of symptoms. Our arrival less than 6 minutes from call.

12-lead performed within 2 minutes of patient contact, rapidly moved to ambulance, thanks to the fire department cooperating. Scene time less than 8 minutes. (They're always in the back room of the house.) Less than 10 minute transport to ER. Treatment included: 18 g IV x2, ASA 162 mg PO, NTG x2, high flow O2, Morphine 10 mg IVP, Zofran 4 mg IVP, NTG drip established and titrated to 50 mcg/min by arrival to ER. Unable to transmit ECG, however called ER en route with patient report. Onset to cath lab, less than 40 minutes.

The patient's wife caught us outside the ER a day or so following this call. She told us her husband had gotten 3 stents during cath and would be coming home in a few days.

Everything came together for this patient. Quick access by his wife undoubtedly saved his life. The fire department were invaluable removing this man from his dwelling. I happened to be working for a hospital based EMS service and transported to my hospital. The ER staff know all of us, and trust all of us. This call will always be the best call I'll ever run.

Question: Why did you administer an antiemetic to this pt? Was he (she?) vomiting or was it prophylactic?

Sounds like a good call. Good work. Also, Theotherphil it sounds like you really saved that guys life, no doubts abut it. Congrats man.

[EMS49393]

Purely prophylatic. I believe the benefits of giving an anti-emetic with that large dose of morphine, in the presence of an acute coronary event far outweigh the risks. I'd hate to be in the middle of busting my butt trying to ensure this gentleman arrives to the cath lab alive, only have him start vomiting, thereby increasing the oxygen demand further on the myocardium. In this particular call, I had the gut feeling that the stress of vomiting would end this man's life rapidly.