What is your ER's PCI med protocol?

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    Regardless of whether or not you have a cath lab onsite, can you please share your ER's med list for a PCI?
  2. 11 Comments so far...

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    We have a cath lab. About half of the STEMIs discovered in the field bypass the ER entirely -- if the cath lab can be ready then there's no need to stop in the ER.

    For ER patients the meds given are ASA, Plavix/Effient, and a heparin bolus. Maybe morphine if the pain is intense. Maybe NTG for pain if accompanied by elevated BP.
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    Cath lab on site with the cath lab team in house from about 0600 - 1700 (maybe 1800 can't remember) and on call the rest of the night. They have to live within 30 minutes of the hospital. As far as meds, all our cardiologists want Plavix and ASA given, never heparin. Also, we are to have two large bore IV sites, connected to NS and extension tubing. We try to avoid giving them anything other than NTG since they are essentially in the ER to get STEMI confirmation, IV access, and a stretcher to cath lab.
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    We have no Emergent cardiology services on site a rural facility, all true cardiac patients are transferred, med protocol depends on the accepting cardiologist. Although we make sure they have received ASA and most cases heparin bolus/gtt, recently we have been using integrallin more. Also, most are asking that we don't use activase, anyone else experiencing that?
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    Quote from WRNCEN
    We have no Emergent cardiology services on site a rural facility, all true cardiac patients are transferred, med protocol depends on the accepting cardiologist. Although we make sure they have received ASA and most cases heparin bolus/gtt, recently we have been using integrallin more. Also, most are asking that we don't use activase, anyone else experiencing that?
    NTG as well, usually a given.
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    Quote from WRNCEN
    We have no Emergent cardiology services on site a rural facility, all true cardiac patients are transferred, med protocol depends on the accepting cardiologist. Although we make sure they have received ASA and most cases heparin bolus/gtt, recently we have been using integrallin more. Also, most are asking that we don't use activase, anyone else experiencing that?
    If they are being transferred, heck no I wouldn't want Activase used. That's a very high risk med with lots of serious adverse effects that need continuous monitoring. I wouldn't rely on an EMS crew (no offense, I wouldn't rely on some nurses I've worked with either) to monitor a pt that's been given Activase. I've never given it for a STEMI at my facility. We usually have them in the cath lab so quickly that the risk far outweighs the benefit.
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    Quote from brainkandy87

    If they are being transferred, heck no I wouldn't want Activase used. That's a very high risk med with lots of serious adverse effects that need continuous monitoring. I wouldn't rely on an EMS crew (no offense, I wouldn't rely on some nurses I've worked with either) to monitor a pt that's been given Activase. I've never given it for a STEMI at my facility. We usually have them in the cath lab so quickly that the risk far outweighs the benefit.
    I have only used it twice, which I was at that pt beside the entire time and they were transferred out one by flight with an RN/MD on board and the other mobile icu that requires an RN in my state of practice. This has been a few years ago, but was amazing to watch and see the patient improve. I agree with you there are many ems/RN that I wouldn't rely on as well. I think the risk outweighing the benefit is the key factor, but when we are rural and can't get the pt to cath lab in an efficient time (many times the bird isn't an option due to weather) this can be a great option for applicable patients.
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    Quote from WRNCEN
    I have only used it twice, which I was at that pt beside the entire time and they were transferred out one by flight with an RN/MD on board and the other mobile icu that requires an RN in my state of practice. This has been a few years ago, but was amazing to watch and see the patient improve. I agree with you there are many ems/RN that I wouldn't rely on as well. I think the risk outweighing the benefit is the key factor, but when we are rural and can't get the pt to cath lab in an efficient time (many times the bird isn't an option due to weather) this can be a great option for applicable patients.
    Oh yeah, I definitely understand the rationale for a rural hospital where PCI will be delayed. Never seen the mobile ICU, that's pretty cool actually.
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    Mobile icu is absolutely awesome they have everything and have lots of room! We also have a wonderful children's hospital who has a nicu mobile unit that is out of this world.
  11. 0
    Quote from NeoPediRN
    Regardless of whether or not you have a cath lab onsite, can you please share your ER's med list for a PCI?
    I work in an accredited chest pain center, and we use ASA, NTG, lopressor, Plavix, heparin, morphine, and a statin. Zofran if nauseated/vomiting. There are always cases where one or more of those might be contraindicated, and there are certain cardiologists who specifically request no Plavix, but those are the basic drugs we give. We used to give a lot of integrilin, a double bolus then a drip, but that was before the 90 minute door to balloon time was made a core measure...it's been a while. I personally haven't given it in about five or six years, but we still get some transfers in with it hanging.


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