clot busters versus cath lab?

Specialties Emergency

Published

Specializes in ED, PCU, Addiction, Home Health.

I have a question.......

I just returned to working in a nice small ER after having been at a Level I ER a few jobs ago. In the Level I we didn't use any clot busters for CP, we just did Tridil/Heparin and down the hall to the cath lab.

The "small" (5 bed) ER I'm at now will transfer patients down the road to the Level I for intervention, and they say mostly they just hang the same meds because it's a short trip.

At what point do the clot busting meds become appropriate? I know there are lots of factors you need to review based on medical hx - - - - but is the final choice based on time/distance from a cath lab???

Thanks so much! I am trying to brush the dust off those neurons in my head that used to "know" this stuff!

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Specializes in Trauma/ED.

We do not have a cath lab in one hospital I work in and we use thrombolytics on patients being transported by ambulance and Integ/hep/nitro on patients transported by helicopter--depends on if they are flying that day or not.

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Specializes in Rural Health.

We are about 60-75 mins via ground to the nearest cath lab. We leave it up to the admitting cardiovascular doc as to whether or not we use Retavase. Usually they determine it. I have no clue what the deciding factors are though. Sometimes it depends on transportation routes (ground vs. air) sometimes they look at the EKG and say to give them and sometimes a very similar EKG they say to wait. Some cardiovascular docs want to go straight to cath lab and others don't and I don't know the time frame after giving Retavase vs. going to cath lab, etc....

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Our criteria in Eastern NC is a pt presenting to an ED with STEMI (ST elevated MI) should be on the cath lab table with balloon opened in culprit lesion withing 90 min of presentation. If pt presents to facility without ability to do interventional cath, pt is transported to nearest facility (us). If the distance to us is far enough that pt can't reasonably get here and on the table in 90 min, then they get thrombolytics (unless they have a contraindication - ie recent stroke, bleed etc). It's all about time. . . time is muscle.

Hope this helps,

Terri Greenville, NC

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Specializes in Emergency & Trauma/Adult ICU.

No thrombolytics here ... to cath lab in 30 minutes or less.

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Specializes in Emergency.

Our cath lab used to only be open 9-5 M-F, then on call after that. So if it was after hours we ALWAYS did thrombolytics (unless contraindicated). If the thrombolytics failed (or the patient wasn't a candidate) then cath lab team was paged to come in. Now that we're 24hrs, its straight to the cath lab 100% of the time. In outlying hospitals, unless they can get to a cath lab within 90 minutes, TNK is used.

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Specializes in ER, Trauma, ICU/CCU/NICU, EMS, Transport.
Our criteria in Eastern NC is a pt presenting to an ED with STEMI (ST elevated MI) should be on the cath lab table with balloon opened in culprit lesion withing 90 min of presentation. If pt presents to facility without ability to do interventional cath, pt is transported to nearest facility (us). If the distance to us is far enough that pt can't reasonably get here and on the table in 90 min, then they get thrombolytics (unless they have a contraindication - ie recent stroke, bleed etc). It's all about time. . . time is muscle.

Hope this helps,

Terri Greenville, NC

This is the standard for PCI vs TPA...however some places are "pushing" it to 60 minutes to the table....

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This is the standard for PCI vs TPA...however some places are "pushing" it to 60 minutes to the table....

We try 20 minutes door to balloon

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