Bypasses (STEMI + Stroke + Sepsis) 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 contraindications?
Who can still permit transport to the PCI centre?
CTAS 1 and the paramedic is unable to secure the pt’s airway or ventilate
12-lead ECG is consistent with a LBBB ventricular paced rhythm, or any other STEMI indicator
Transport to a PCI centre is ≥60min from pt contact
Pt is experiencing a complication requiring PCP diversion such as:
* Moderate to severe respiratory distress or use of CPAP
* Hemodynamic instability or symptomatic SBP GREATER than 90mmHg at any point
* VSA wihotut a ROSC
Pt is experiencing a complication requiring ACP diversion such as:
* Ventilation inadequate despite assistance
* Hemodynamic instability unresponsive/not amendable to ACP treatment/management
VSA without a ROSC
The Interventional Cardiology Program
Acute Stroke Bypass Protocol
What are the symptoms you are assessing for?
When do you transport to a Designated Stroke Centre?
Inappropriate words or mute
Slurred speech
Unilateral arm weakness or drift
Unilateral leg weakness or drift
Unilateral facial droop
if the patient meets the criteria listed in paragraph 1 of the Acute Stroke Bypass Protocol above
AND
it’s within 6 hours of a clearly determined time of symptom onset
or 6h since the patient was last seen in his/her usual state of health
Acute Stroke Bypass Protocol
What are the CONTRAINDICATIONS?
What if the patients symptoms persist after treating the BGL?
What do you do if the pt meets the conditions and no contraindications?
CTAS 1 and/or an uncorrected airway, breathing or circulation issue
Stroke symptoms resolved prior to paramedic arrival or assessment
Blood Glucose Level <3mmol/L
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
It’s no longer considered a contraindication.
perform a secondary screen for a Large Vessel Occlusion (LVO) stroke using the Los Angeles Motor Scale (LAMS)
Acute Stroke Bypass Protocol
Who do you inform and what information do you include to help determine the most appropriate destination?
What do you do if the patients resolve or improve during transport?
What centers are included as A Designated Stroke Center? (3) - regardless of what?
CACCC/ACS - inform them of the LAMS score
Continue tranpost to the Designated Stroke Centre
Regional Stroke Centre, District Stroke Centre or a Telestroke Centre regardless of EVT capability.
Large Vessel Occlusion (LVO) Assessment
Use LAMS for all probable stroke pts presenting within 24h of symptom onset - what does it stand for?
When do you perfom the LVO assessment?
What’s the purpose of LAMS SCORE?
The Los Angeles Motor Scale
It’s a simple, reproducible, and rapid way to identify severe strokes in the prehospital setting. The rapid assessment is time-sensitive to interventions such as thrombolysis and endovascular
therapy (EVT) as it’s directly linked with improved long-term neurological outcomes for stroke patients.
LAMS ≥4 has a sensitivity of 81% and specificity of 89% for predicting large vessel occlusion (LVO).
Sepsis Notification
What is Criteria 1?
What is Criteria 2?
Why is hx of fever an option?
Current infection i.e.
* UTI
* Pneumonia
* Recent post-op
* Cellulitis
OR
suspected infection and known immunocompromised
* Active chemotherapy
* Transplant patient
* HIV
History of fever or present temperature >38.3C
Because if they used to have a fever but now don’t then it could mean they’re decompensating - no longer able to maintain that temperature = not good
Sepsis Notification
What is criteria 3?
What are other signs of hypoperfusion?
What are 3 important factors?
2 or more signs of hypoperfusion including:
* SBP <90 mmHg
* HR ≥ 100 bpm
* RR ≥24
* Altered LOC/LOA
Greater capillary refill time
Thirst
Cool/clamy skin
Minimize time on scene
Return on a high priority
Notify receiving hospital
Sepsis Notification
What is Sepsis?
What are the types of shock (6)?
When G- bacteria is attacked by the immune system the outer mambrane is destroyed releasing endotoxins that further release a cascade of immune mediators such as:
* Prostacyclin - causes widespread vasodilation
* Histamines
* Luekotrines
* Thromboxane
Extreme response to infection- body’s own tissues/organs become injured
Hypovolemic
Obstructive
Cardiogenic
Neurogenic
Anaphylactic
Septic
STEMI - reciprocal changes
P.A.I.L.S
Show me the leads and which artery supply what area?
What are the major arteries that supply the heart?
The reciprocal changes are expected to appear in the adjacent zones
RCA - Right coronary artery
LAD - Left Anterior Descending Artery
Circ. - Circumflex artery
