[OH RN,BSN]

Here's the situation: We get in the "doosie" pt having an AMI... and we start our protocol of MONA..although not always in that order . Then usually follows a beta blocker of some sort, obviously depending on what is wrong with the pt... usually metoprolol IVP x3. Simultaneously, in the critical pt... either heparin, reappro, integrelin.etc. is started. Now we find we need to transfer them out... due to no open heart available at our hospital if circumstances would arise during their heart cath. What happens after this??? Are you lovely techs out there and RN's cursing us due to the bleeding times and such, or are the half-lives short enough it doesn't matter? Wanting to know what goes on elsewhere.... after the transfer to YOUR facility . Can you clue me in? Thanks.

[TennRN2004]

Originally Posted by OH RN,BSN

Here's the situation: We get in the "doosie" pt having an AMI... and we start our protocol of MONA..although not always in that order . Then usually follows a beta blocker of some sort, obviously depending on what is wrong with the pt... usually metoprolol IVP x3. Simultaneously, in the critical pt... either heparin, reappro, integrelin.etc. is started. Now we find we need to transfer them out... due to no open heart available at our hospital if circumstances would arise during their heart cath. What happens after this??? Are you lovely techs out there and RN's cursing us due to the bleeding times and such, or are the half-lives short enough it doesn't matter? Wanting to know what goes on elsewhere.... after the transfer to YOUR facility . Can you clue me in? Thanks.

If the patient needs to be transferred for surgery right away, they may come to our open heart unit as a pit stop just long enough for the OR team to get prepped and ready (I work nights, so they have to be called in). If it's during the day, they'll usually go for an emergent open heart and surgery takes care of any issues that arise related to bleeding, druges given, etc. I've never heard of any complaints at all related to pts being transferred from facilities that don't do the open hearts. All of our transfers have been well taken care of and well documented before they arrive so we have a clear picture of what was done and what needs to be done. I will tell you when they get cathed and come after surgery to us with a sheath, we hate to pull sheaths, but I guess no one really enjoys pulling a sheath...

[msjangir]

After receiving a patients from outside hospital where surgical facilities not available. if patient is of AMI we start him on AMI protocol. Fisrt of all we prepare the patient for cardiac cath because from which only we can ruleout that patient need PTCA or surgery.
If cardiac cath findings are TVD than we head towards surgery and OR Team inspects the patient that he is suitable for surgery or not. Because there are lot of issues which we have to see before taking patient to OR. His premedication history of clopigrel and aspirin, because this two drugs play a great role in causing bleeding.
Our OR team prefer to take patient who discontinued these medicines before one week. ANd for emergency the protocol is different for surgery.

[TennRN2004]

[quote=mahirn]His premedication history of clopigrel and aspirin, because this two drugs play a great role in causing bleeding.
quote]

Do you get TEG levels in your country? It helps us estimate to what degree bleeding will be a problem.