Adult Cardiac Protocol Section 1 V3 - contiguous mm ST/J 2

mm ST/J point point ST/J mm mm ST V3 for women - ≥ 2 1

≥ elevation in V2 men for ≥ 1.5 in point elevation V2 ECG software diagnoses Acute MI (symptomatic) ≥ Segment elevation in leads Acute MI / STEMI Acute MI /

• • • STEMI Definition: • Trauma vs. Medical Trauma vs. MyocardialAngina vs. infarction Pericarditis Pulmonary embolism Asthma / COPD Pneumothorax aneurysm or dissection Aortic hernia Hiatal or reflux GE Esophagealspasm Chest wall injury or pain Pleural pain or Overdose: Cocaine Methamphetamine

Differential • • • • • • • • • • • • Minutes 15 like

- ≤ STEMI if capable Reperfusion Checklist Reperfusion Transport based on: on: Transport based AC 4 AC If transporting to Non PCI Center Immediate Transmission of ECG EMS Triage and Destination Plan Immediate Notification of Facility of Notification Immediate Keep Scene Time to Time Keep Scene P B More likely dyspnea, to have N/V, weakness, back or jaw pain Notify DestinationNotify or CP (pain, pressure, aching, vice aching, pressure, CP (pain, tightness) arm, epigastric, (substernal, Location shoulder) jaw, neck, of pain Radiation Pale, diaphoresis Shortness of breath Nausea, vomiting, dizziness Time of Onset Women: Contact Medical Control Contact YES

• • • • • • • • • • Signs Symptoms andSigns eferred 100) Chest Pain: Cardiac and STEMI Cardiacand Pain: Chest

R rovocation ≥ P NO 325 mg PO 10) Or Any local EMS System changes to this document must follow the NC OEMS Protocol Change Policy and be approved by OEMS and be approved Policy follow the to document System by OEMS Change changes Any must NC Protocol this local EMS - and (BP adiation / Cardiac Monitor if indicated if indicated alliation / Protocol AC 5 IV / IO Protocol UP 6 Protocol AM 5 R See box to right Acute MI / STEMI Acute MI /

/ P if prescribed to patient

Hypotension / Shock / Shock Hypotension 12 Lead ECG Procedure Repeat every 5 minutes x 3 minutes every 5 Repeat CHF / Pulmonary Edema Edema CHF / Pulmonary Nitroglycerin 0.3 / 0.4 mg SL / 0.4 0.3 Nitroglycerin

Aspirin 81 mg x 4 PO (chewed) mg x Aspirin 81 nset uality (crampy, constant, sharp, egion / everity (1 ime (onset /duration / repetition) / /duration ime (onset Repeat every 5 minutes as needed dull, etc.) R S T Recent physical exertion exertion physical Recent O Q Levitra / vardenafil, Cialis / tadalafil) Cialis vardenafil, / Levitra Past medical history (MI, Angina, menopausal) post Diabetes, Allergies Age sildenafil, / (Viagra Medications Nitroglycerin 0.3 / 0.4 mg Sublingual / 0.4 0.3 Nitroglycerin Revised 01/01/2021

• • • • • • • • History • • P P A B Adult Cardiac Protocol Section 2 cath hydration. - mL as pre 500

– AC 4 AC Lead ECG in the PCR as a Procedure along with the interpretation along with the interpretation Procedure the PCR as a Lead ECG in - stamp facility STEMI notification and make notification as soon as possible. - Chest Pain: Cardiac and STEMI Cardiacand Pain: Chest vomiting, and back or jaw pain. pain. jaw or back and vomiting, (Paramedic). hours or Cialis (tadalafil) in the past 36 hours due to potential severe hypotension. severe hours due to potential the past 36 in (tadalafil) hours or Cialis hypotension in an inferior MI and should already hypotensive. NOT be avoided unless Elevation Myocardial Infarction) - Any local EMS System changes to this document must follow the NC OEMS Protocol Change Policy and be approved by OEMS and be approved Policy follow the to document System by OEMS Change changes Any must NC Protocol this local EMS Women, diabetic patients, and the elderly often experience only weakness, shortness of breath, nausea/ of breath, shortness weakness, only experience often elderly and the patients, diabetic Women, Document and time Document and 12 time of the Document the Pressure, squeezing, fullness,in the chest. or pain stomach. or jaw, neck, back, the arms, both or one in discomfort or Pain Shortness of breath with or pain. without chest Sweating, nausea, weakness, and/or lightheadedness. Positive Reperfusion Checklist should be transported to the appropriate facility based on STEMI EMS Plan. Triage and Destination for intervention. artery radial the right use PCI centers left arm: Many in the IV sites 2 Consider placing Consider placing defibrillator pads on patient a precaution. as of 250 bolus Ringers or Lactated Saline Consider Normal Scene time goal is < 15 minutes. Avoid Nitroglycerin in any patient who has used Viagra (sildenafil) or Levitra (vardenafil) in the past 24 the past in (vardenafil) or Levitra (sildenafil) Viagra used who has in any patient Avoid Nitroglycerin to cause NOT more likely It is infarction. type myocardial any during hypotension cause may Nitroglycerin Agency medical director may require Contact of Medical Control prior to administration. If patient has taken nitroglycerin without relief, consider potency of the medication. opioids. and nitroglycerin of administration after for hypotension Monitor EMT may administer Nitroglycerin to patients already prescribed medication. May give from EMS supply. Cardiac related symptoms in men and women: STEMI (ST Nitroglycerin: Recommended Exam: Mental Status, Skin, Neck, Lung, Heart, Abdomen, Back, Extremities, Neuro Extremities, Back, Abdomen, Lung, Heart, Neck, Status, Skin, Mental Exam: Recommended indicatorsItems in Red Text are the key performance Cardiac for the EMS Acute (STEMI) Care Toolkit Revised 01/01/2021

• • • • • • • Pearls • •