- New Chest Discomfort Suggestive of
Ischemia algorithm
- The algorithm is streamlined but still focuses
on risk stratifications using the 12 lead ECG
- New EMS dispatcher pre-arrival
instructions: Chew 160-325 Aspirin
- New Chest Pain Checklist for
Stemi Fibrinolytics Therapy to match the most recent
criteria published by ACC/AHA
- Step One-
- Has patient experienced chest discomfort for
greater than 15 minutes and less
than 12 hours?
- Does ECG show STEMI or new presumably new
LBBB?
- If yes was answered to the above questions you
will proceed to Step two. If NO was answered you
will stop
- Step Two-
- Are there contraindications to fibrinolytics? If
Any of the following is checked YES, Fibrinolytics
MAY BE contraindicated
- SBP greater than 180mm hg
- DBP greater than 1110 mm hg
- Right Vs Left arm systolic BO difference
greater than 15 mmhg
- Significant closed head/facial trauma within
the previous 3 months
- Recent (within 6 weeks major trauma, surgery
(including eye surgery), GI/GU bleeding
- Pregnant female
- Serious systemic disease
- Step Three
- Is patient at high risk? If ANY
of the following is checked YES, CONSIDER
Transport/Transfer to PCI facility
- Heart rate greater than or equal to 100 bpm
and SBP less than 100 mmhg
- Pulmonary Edema
- Signs of shock
- Contraindications to fibrinolytics therapy
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