Bypasses Flashcards
STEMI Hospital Bypass Protocol
What are the CONDITIONS a patient must have to tranpost them to the PCI?
What do you do if the ECG normalizes?
≥18 years of age
Chest pain or equivalent consistent with cardiac ischemia/myocardial infarction
Time from onset of current episode of pain <12 hours
12-lead ECG indicates an acute AMI/STEMI:
- At least 2 mm ST-elevation in leads V1-V3 in at least two contiguous leads
AND/OR
- At least 1 mm ST-elevation in at least two other anatomically contiguous leads
OR
- 12-lead ECG computer interpretation of STEMI and paramedic agrees.
Continue to follow the protocol
STEMI Hospital Bypass Protocol
What are the top 3 CONTRAINDICATIONS?
Who can still permit transport to the PCI centre?
CTAS 1 and the paramedic is unable to secure patient’s airway or ventilate
12-lead ECG is consistent with a LBBB, ventricular paced rhythm, or any other STEMI imitator
Transport to a PCI centre ≥60 minutes from patient contact
The Interventional Cardiology Program
STEMI Hospital Bypass Protocol
Under the CONTRAINDICATIONS what would be a complication in which PCP diversion was required?
Who authorizes the transport?
What would be a complication in which ACP diversion was required?
Moderate to severe respiratory distress or use of CPAP
Hemodynamic instability or symptomatic SBP <90 mmHg at any point
VSA without ROSC
CACC/ACS
Ventilation inadequate despite assistance
Hemodynamic instability unresponsive/not amenable to ACP treatment/management
VSA without ROSC.
Acute Stroke Bypass Protocol
What are the CONDITIONS a patient must have in order to be transported to the Designated Stroke Centre?
Where will you be redirected in select regions with LVO + pts within 6h?
Who do you inform to then be able to determine to proper location?
Patient with a new onset of at least one of the following symptoms:
- Unilateral arm/leg weakness or dift
- Slurred speach or inappropriate words or mute
- Unilateral facial droop
The patient’s symptoms had to have been determined/found within 6h
The closest EVT Centre
CACCC/ACS - can tell you to go to the regional stroke centre, district stroke centre, or telestroke centre
Large Vessel Occlusion (LVO) Assessment
Use LAMS for all probable stroke pts presenting within 24h of symptom onset - what does it stand for and how do you use it?
When do you perfom the LVO assessment?
The Los Angeles Motor Scale
After you’ve assessed the contraindications AND they don’t meet any
Acute Stroke Bypass Protocol
What are the CONTRAINDICATIONS?
CTAS 1 and/or an uncorrected airway, breathing or circulation issue
Stroke symptoms resolved prior to paramedic arrival or assessment
Blood Glucose Level <3 mmol/L (if persistant after improval than no longer contraindicated)
Seizure at the onset of symptoms or that is observed by the paramedic
Glasgow Coma Scale <10
Terminally ill or is in palliative care
Duration of transport to the Designated Stroke Centre will exceed two hours
