Chest Pain Coordinator’s role in the hospital system and with EMS  

Chest Pain Coordinator and the Interventional Cardiologist both try to meet EMS in the ED to begin care of the STEMI patient

Importance of EMS performing a 12-lead EKG in the field and transmitting the EKG to the receiving facility 

High quality EKG’s being done in the field lead to EMS bypassing the ER and taking the STEMI patient directly to the cardiac catheterization lab

UH staff partnering with EMS to work together as a high performing team for decreased door to balloon times 

“When in doubt, page it out” when activating a STEMI from the field

The interpretation of the monitor print out (computer interpretation) VS. the interpretation of the EKG by a provider (human interpretation) 

“Treating the patient, not the monitor” 

Importance of EMS giving an accurate patient story (crushing chest pain, looks terrible) in a report to the ED Physician

Not all chest pain is cardiac, remember your differential diagnosis for other causes 

Atypically STEMI patients’ presentation

• Women 

• ABD pain

• Flu like symptoms

• Diabetics 

Skin preparation is KEY to have good electrode contact to the patient, which will lead to a higher quality EKG with less artifact 

Remember to not leave your EKG electrodes out and do not preload your stickers on your monitor because the gel will dry out 

Purchase a higher quality electrode, cheaper is NOT always better 

LIFENET system allows physicians and interventional cardiologist to see the patients EKG from anywhere, even on their phone 

Inferior wall MI’s are more sensitive to nitroglycerin, and can cause hypotension, but it does not mean that you are not able to dose a patient with nitroglycerin. The patient’s blood pressure will dictate the usage of nitroglycerin 

When you have ST depression, it does not localize what area the blockage is occurring (i.e., in the RCA, etc.) 

When in doubt, stick with patients’ presentation and a high-quality EKG

The hospital utilizes a patient’s old EKG to compare to a current EKG and look for changes 

Sgarbossa's Criteria for MI in Left Bundle Branch Block

A deeper dive into Troponin levels and EMS drawing labs in the field 

ASA, Brilinta, and Heparin, help with perfusion of the occluded vessel, and can result in a more normal EKG after given to a STEMI patient (EMS with long transport times)

Direct Anticoagulants (DOAC’s) 

• Dabigatran

• Rivaroxaban

• Apixaban

• Edoxaban

Antiplatelet Medications

• Plavix

• Brilinta

• Effient

• Ticlid

Other Anticoagulant Medications

• Eliquis

• Pradaxa

• Savaysa

• Arixtra

• Xarelto

• Coumadin

• Bevyxxa

Stent placement does not work without two appropriate drugs being given. I.e., ASA, Heparin, Brilinta. The P2Y12 inhibitor needs to be on board to prevent stent reocclusion. 

Decisions with ROSC patients that will lead to them going to the cardiac catheterization lab or that might make them hold on going to the lab 

Femoral artery vs. radial artery catheterization access 

Impella Heart Pump 

Step-by-step process of patient treatment in the cardiac catheterization lab 

Stent size and why it matters 

***If you are interested in the educational observer program for UH Geauga’s Cath Lab please email: Geoffy.Patty@UHHospitals.Org ***