Question: At our recent recertification, I posed a question that was answered by a doctor. This was regarding the ability to call a cardiologist if we had a patient with a STEMI who did not have chest pain. Her answer was: not at this time. However, in conversation with medics from other classes, this seems to contradict what they have been told. Can you please clarify?
br>Also, are we to continue to understand that once a patient is out of the STEMI protocol (e.g. with vitals) that they continue to be so even if the vitals improve to within proper range?
We apologize for the perceived confusion, we strive to maintain a consistent message across the program and it appears that may not have been the case here. STEMI bypass is for the consideration of urgent PCI intervention in the setting of STEMI. In the setting of ECG findings consistent with STEMI in the absence of chest pain, one would have to consider the likelihood that the ECG findings are more likely a STEMI mimic that an actual STEMI. Therefore, we would recommend contacting the interventionalist on call only when there are ECG findings consistent with STEMI and the patient has chest pain or discomfort that is felt to be ischemic in nature. Otherwise, we would recommend transporting that patient to closest appropriate emergency department for assessment of the patient and the ECG to prevent over triage, and potential over activation of the cath lab.
With regards to the exclusion criteria for the STEMI bypass, the general teaching has been that if the patient meets one of the exclusion criteria then they should be transported to the closest ED for initial assessment and stabilization. The rationale behind this is to ensure appropriate staff and resources are readily available to manage a potentially unstable patient, which may not always be possible on arrival to the cath lab.