Evaluation and Management of ST-Segment Elevation Myocardial Infarction in the Emergency Department | Points & Pearls
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Evaluation and Management of ST-Segment Elevation Myocardial Infarction in the Emergency Department

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Points & Pearls Excerpt

  • The location of the coronary occlusion will produce ST-segment elevation in a predictable pattern on ECG. (See Figure 3.)
  • The goals of prehospital management of STEMI are early recognition, administration of aspirin, and timely transport to a PCI-capable facility for reperfusion.
  • Patients with suspected ACS should have an ECG performed within 10 minutes of the first medical contact, and serial ECGs should be performed liberally to monitor for changes.
  • Bypassing non-PCI capable facilities to get the STEMI patient to a PCI-capable facility is safe, and is recommended if the first medical contact-to-balloon time is <90 minutes and transport time is <30 minutes.17
  • Echocardiography is a noninvasive way to assess for regional wall motion abnormalities or other pathologic findings, and it can help confirm a diagnosis.
  • A patient presenting with signs and symptoms of ACS and ST elevation on ECG should be managed as a STEMI regardless of the hs-cTn level.28
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Publication Information
Authors

Marshall Frank, DO, MPH, FACEP; Carson Sanders, BS, NRP, CCEMT-P; Bryan P. Berry, MD, BCEM, FACEP

Peer Reviewed By

James Morris, MD, MPH; Douglas L. Robinson, DO, MS; Andrew Schmidt, DO, MPH

Publication Date

January 1, 2021

CME Expiration Date

January 2, 2024

CME Credits

4 AMA PRA Category 1 Credits™, 4 ACEP Category I Credits, 4 AAFP Prescribed Credits, 4 AOA Category 2-A or 2-B Credits.

Pub Med ID: 33320487

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