NORTH COAST EMERGENCY MEDICAL SERVICES Policy # 5328

POLICIES AND PROCEDURES

Subject: Medical Control

Thrombolytic Therapy Pre-Alert Procedure

Associated Policies: 6006, 6511

I. Authority and Reference (incorporated herein by reference)

A. Division 2.5 of the Health and Safety Code.

B. California Code of Regulations, Title 22.

C. North Coast Emergency Medical Services Policies and Procedures.

II. Purpose

To provide a means by which patients eligible to receive thrombolytic therapy may be more rapidly identified in the prehospital setting. Emergency Departments (EDs) receiving these patients may then decrease the time to initiation of thrombolytic therapy, thereby limiting the amount of cardiac damage and reducing morbidity and mortality of the patient with acute myocardial infarction (AMI).

III. Procedure

A. Thrombolytic Therapy Pre-Alert Procedure

1. Prehospital personnel should notify their base hospital as soon as possible of the suspected AMI patient’s age, gender, and clinical findings, including cardiac rhythm (or 12-lead electrocardiogram (EKG) if available) and pertinent medical history.

2. Information contained in the pre-alert checklist should also be relayed to the base hospital (and in turn to the receiving hospital, if different) in order to facilitate the initiation of thrombolytic therapy in the ED. Ability of prehospital personnel to complete the checklist will depend on patient condition, estimated time of arrival (ETA) at the ED, and other factors. NOTE: Scene time should not be delayed, nor should completion of the checklist interfere with other patient care.

3. It is recommended that the ED utilize the information from this checklist to speed the delivery of thrombolytic therapy to eligible patients. Steps taken might include, but are not limited to:

a. 12-lead EKG available in the ED upon patient arrival.

b. Free the ED physician from less critical patient care.

c. Prepare the thrombolytic agent and other medications (may not include actually mixing the thrombolytic agent).

4. Ideally, thrombolytic therapy should be initiated in every eligible patient with AMI within 30 minutes of their arrival in the ED.

 

 

 

 

 

 

 

B. Thrombolytic Therapy Pre-Alert Checklist

1. Inclusion Criteria

a. Clinical findings consistent with AMI such as:

1) Chest pain > thrity (30) minutes - may be accompanied by jaw, arm, or back pain.

2) Sudden onset shortness of breath.

3) Nausea / vomiting.

4) Pale, cool, diaphoretic skin.

b. Recent onset of AMI symptoms (< six (6) hours).

2. Exclusion Criteria

    1. Active internal bleeding
    2. History of cerebrovascular accident (CVA)
    3. Intracranial or intraspinal surgery or trauma within the past two (2) months.
    4. Known intracranial neoplasm, arteriovenous malformation, or aneurysm.
    5. Known bleeding disorder.
    6. Severe uncontrolled hypertension.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Approved: Date:

Approved As To Form: Date: