In the companion document under the medical cardiac arrest directive it lists reasons for early transport. Under here it lists thrombosis (pulmonary and coronary). So to my understanding, if we have a VSA we believe to be caused by a coronary thrombosis (a STEMI) we are to do 1 analyze? In the past it has been said that we are to treat a suspected MI VSA as a medical cardiac arrest and run the entire protocol on scene. Can you please clarify?

I had a call the other day, 40s female with 7/10 central chest pressure radiating to her left arm, under left breast. PT said that how she felt now is identical to how she felt a few years ago; she had SCAD as in sudden coronary arterial dissection then and had stents put in. How does ASA and nitro play a role in this case, because it sounds textbook ischemic but with such a rare and bizarre medical history. Please let me know what you think?

When we do a 12-lead and have inferior involvement, the directive states that we assume there is right sided ventricular MI and must confirm with V4R, and then states we should never give nitro for right sided ventricular STEMI. All of that is clear, but what I am wondering is that if the V4R is negative, does that clear the pt for Nitroglycerin use for the inferior STEMI, or does that simply help confirm the STEMI for the emergency department? Thanks.

My question is regarding STEMI bypass and hyperacute T Waves. We were called out for a 60’s male patient experiencing chest pain after some physical exercise. It was quite apparent patient was likely having a cardiac event upon arrival and first examination. Patient had 8/10 midsternal pain (pressure) with radiation into shoulders. Patient was clammy, cool and diaphoretic. Patient had a weak radial pulse. After giving ASA 12 leads were obtained. Each showing hyperacute T waves in the chest lead V2 – V5. No elevation is noted, upon multiple 12 leads. No nitro was given as heart rate was below 60, but a lock was established. Patient was stable and wouldn’t have any of the contraindication to STEMI bypass. We are a rural service and closest hospital is 7 minutes away and transport time to the cath lab would be roughly 25 minutes. Just curious how base hospital would like us to proceed on these calls in the future? a – go directly to closest hospital as there is no elevation yet and doesn’t quite meet STEMI bypass b- call the closest cath lab and let the cardiologist decide c- first call base hospital to ask for further direction to see if cath lab should be called, then proceed from there. Thanks in advance

The ALS PCS 4.5 STEMI directive follows the BLS V3.0.1 criteria and no longer has a pulse rate of <50 as a contraindication for bypass. Does this mean a bradycardic patient with a pulse in the 40s can now be transported on a STEMI bypass? In the past medics where taught differing regions would have slightly different STEMI receiving acceptance criteria. Are there any considerations we as medics should consider for STEMI receiving hospitals in our governing region?

Wondering what your thoughts are in regards to administering nitro to a patient with atypical angina symptoms and no presentation of chest pain. For example, is it ok for us to administer nitroglycerin if a medic is presented with a female patient who states she becomes nauseated from angina and explains she is prescribed nitro for the symptom? I discussed this question with my colleagues and I have found there is a 50/50 split in regards to those of us who would use nitro or not. I think it is a good question to ask given the differencing of opinion in the field.

If patient receives ASA from a certified provider, such as but not limited to other paramedics, doctors/nurses from clinics, are we required to administer another dose of ASA to the ACS patient. Also, does the patient have to have chest pain to administer ASA?