Evaluation and Management of ST-Segment Elevation Myocardial Infarction in the Emergency Department

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