Hospital EMS Case Review STEMI Meeting


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Hospital EMS Case Review STEMI Meeting

  1. 1. STEMI Case ReviewImproving System of Care for the AMI Population June 20th, 2011
  2. 2. Review Process•  Introductions •  Results•  Background •  - times•  Communication •  - patient outcome•  Diagnosis •  Barriers and•  Care Provided Opportunities•  Hand-off of Patient •  Conclusions •  Follow Up Needed
  3. 3. Participants•  Patient•  RN in Charge of Medic Tent at Scottish Games*•  Mobile Care Ambulance Service•  Chest Pain Center•  Call Center•  STAT RN•  Cardiac Catheterization Lab *•  Cardiologist** Presenters
  4. 4. 2011 Scottish Games at Furman University MEDICTENT
  5. 5. Freedom Weekend AloftMEDIC TENT (Mobile Care also covering)
  6. 6. First Aid/Medic TentJeanne Sandahl, Nurse Manager
  7. 7. Scottish GamesSword Fights
  8. 8. Scottish GamesCaber Toss
  9. 9. Method of Travel to Patient(in Bagpiper Tent)
  10. 10. GHC Mobile Care Ambulance Service•  Mission: Transport GHS patients•  Mobile Care established in April of 1972 and is an affiliate of GHS UMC•  Primarily inter facility, discharges and Referral Center transports•  EMTs and Paramedics•  Second highest transport volume in Greenville County; approximately 10,000 annually•  Mutual Aid Agreement with GC EMS•  - Provides 911 ‘back-up’•  All ambulances ‘advanced life support’ staffed and equipped
  11. 11. MCAS Staff•  30 Paramedics (8 CC EMT-P)•  13 EMTs•  2 RNs•  2 in Nursing School•  11 also work for GC EMS or other 911 agencies•  9 also work for Fire Departments (3 Lieutenants and 1 Captain)
  12. 12. MCASMedical Control•  Martin E. Lutz, M.D.•  Medical Director, Emergency Services•  Vice President Medical Staff•  Also Medical Control for:•  Greenville County EMS•  GHS Med Trans (medical helicopter)
  13. 13. Mobile Care CrewJohn Reid, CC EMT-P•  EMT since 1998•  Works also PT for GC EMS•  CC EMT-P in 2010•  John also provided Medic coverage at 2010 Scottish Games, to Prince Edward
  14. 14. Mobile Care CrewBeth Smith, EMT-I•  EMT for 13 years•  Started EMT career in New York•  Fire Department – 6 years•  Life Link at Roper St. Francis Hospital•  Mobile Care•  EMT –I 2009
  15. 15. PatientChief Complaint, Symptoms andHistory•  Patient: 60year old male•  History•  Family history of coronary artery disease•  Sedentary lifestyle•  Chief Complaint•  Chest Pain•  Symptoms•  Chest pain since approximately 7:30 am; most severe in substernal area and radiating to left arm•  Diaphoretic•  SOB•  Nauseated
  16. 16. Mobile Care Ambulance ServiceInitial EKG 10:20:36 am
  17. 17. Chest Pain CenterActivates STEMI Alert•  STEMI activated via CPC; Dr. Crumpler at 10:36•  Play Recording
  18. 18. Mobile Care Ambulance ServiceCare Provided•  Oxygen initiated via nasal cannula•  Cardiac monitor for ECG•  Nitroglycerin, 0.4 MG•  Peripheral IV initiated•  Heparin•  Taken to GMH Chest Pain Center 4
  19. 19. Mobile Care Ambulance ServiceTimes•  10:00 – Request received via radio•  10:06 – At patient•  10:22 – enroute to GMH•  10:37 – arrived at GMH•  37 minutes from initial notification to arrival at GMH/Chest Pain Center
  20. 20. GMH CardiologyStat RN•  STEMI Role•  - Meet EMS crew at ambulance bay/CPC or approach landing pad and assist with patient transfer (training required).•  - Receive brief report from flight/EMS crew regarding patient stability or changes during transport•  - Introduce self/role to patient and family; verbalize next steps and provide support•  - Review and confirm pre-GHS meds given specific to AMI/cardiac cath•  - Review targeted health history with patient, and biometrics pertinent to cardic cath procedure•  - Perform targeted assessment if time allows•  - Assist with tracking times and documentation•  - Support CPC/CC-ER, cath lab personnel, and cardiologist as required and within scope of practice•  - assist with patient transfer in CCU•  Note: crossed trained for CCL for 2nd STEMI situations
  21. 21. Greenville Memorial HospitalCardiac Catheterization Lab
  22. 22. Cardiac Cath Lab Team•  Dr. Josh Doll - Interventional Cardiologist•  Beth Cook, RN – Circulator•  Mary Sturges, RN – Circulator•  Joelle Bridgesm RN - Scrub•  Leigh Godbee-Stephens, RN, BSN - Monitor•  Gary Szeto, RN – Stat/STEMI RN
  23. 23. CardiologistCarolina Cardiology Consultants•  Hometown: Batesville, Indiana•  Area of Specialization:•  Interventional Cardiology, Structural Heart Disease Therapies, Cardiac Pacing•  College: Indiana University, Bachelor of Science-Biology, Cum Laude, 1996•  Medical School: Indiana University of Medicine, Doctor in Medicine, 2000 Residency: Vanderbilt University Medical Center, 2000-2003•  Cardiology Fellowship:•  Medical University of South Carolina, Interventional Cardiology Medical University of South Carolina, Cardiology
  24. 24. Cardiac CathVital Signs at 11:04 am•  Sp02 98%, HR 66, BP 118/69/76•  11:02:59 – GMH Door Time•  11:03:00 – Greet/table•  11:11:54 – Case Start•  11:23:42 – Balloon
  25. 25. E2BD2B•  77 minutes – E2B (EMS to Balloon)•  43 minutes – GMH D2B (Door to Balloon)
  26. 26. Pre Cath
  27. 27. Stent
  28. 28. Final
  29. 29. Procedure Performed•  INDICATION FOR PROCEDURE:•  Acute anterior ST-elevation myocardial infarction with occlude proximal LAD•  1. Left heart catheterization with coronary angiography and left ventriculography•  2. Percutaneous coronary stenting of the proximal left anterior descending
  30. 30. Cath ReportFindings•  Intervention•  Lesion is a complete thrombotic occlusion of the proximal LAD with TIMI-zero flow•  Conclusions•  Coronary disease with acute thrombotic proximal left anterior descending occlusion•  Successful stenting of the proximal left anterior descending with a bare-metal stent after aspiration thrombectomy•  Mild left ventricular systolic dysfunction
  31. 31. Questions and Thanks to All!