Hi again, from the land of crazy stuff, as work wow and success story!
Background information:
Heart Attacks - blood is not getting to the heart causing it to die due to lack of oxygen, can be in various stages of clots
MI's --stuff about how it is being clotted and how they doc's can figure out where the clot is
PCI -- how to fix it
Cool pictures of how it is doneECG identification - good stuff on ECG and how it helps with identification
American Heart Association has set up a goal that when you come in with a STEMI, the clock starts and we have 90 minutes to hit balloon inflation on the patient. That means the time in the Emergency Department and how fast the Cath Lab (the place the Cardiologist take the patients to and do the PCI) can get the patient and get it done. The faster this is done means the more heart muscle is saved and the better chance the patient has of living a decent life after the procedure (quality of life). Chest Pain Centers help move the process of door-to-balloon time along, helping communities reach a better heart attack survival rate. Our hospital is now a Chest Pain Center and we work with the local EMS to improve the outcome. Historically, Seattle has been the best place to have a heart attack, with Ottawa jumping on board and making a name for its survival rate. But our little Hospital and EMS in backwoods Indiana are doing pretty good.
It was a couple of Sunday's ago, typical Midwestern small/midsized town stuff, local fairs, lots of elderly coming in with flareup of chronic conditions, with minor stuff here and there, but over all a really nice Sunday (Sundays usually suck, tons of patients since USA'ers can't wait on anything). The call on the radio from the paramedic came in, "possible heart alert, pt with CP, syncopal episode, and elevated ST," he described a pretty convincing picture. I was going to be lead (ya! no freaking righting for me!), and two other great nurses went and prepped the treatment room. We had pulled our AMI box, had the EKG there, and all the other gear. The medic came in and gave a brief but complete report, and placed a 44 y.o. male who looked dang near text book for a heart attack (other than being 44...). Anyway, we did all we could and activated the cath lab as soon as the EKG was done (which was pretty much as we were putting him on the stretcher), then began all the other stuff we do for chest pain management of a heart attack, i.e. stuff for pain, stuff for keeping the heart beating, stuff to help the heart beat easier, and getting him and his family informed.
He hit our door at 1515 (3:15pm), we had the cath lab team take him at 1548 (3:48 pm), and his balloon time was 1558 (3:58 pm). That was 43 mins for door to balloon time, and that was on a Sunday afternoon, we had to call in the Cath Lab and Cardiologist. If you want the time from EMS activation to balloon time it was 75 mins, (EMS activated at 1443, i.e. when the call was made to 911), which is great! We could do better, but I'll talk about that later.
We are a Chest Pain Center, meaning we participate in all the AHA stuff on making heart attacks more survivable and preventable, problem is that we are in a small/midsized community, and have to share resources with other hospitals. We are striving to always be under the 90 mins standard of door-to-balloon time, and work with the EMS to improve it. The fact that we got this patient to the treatment he needed on a Sunday, when things were just not there (besides us and EMS), proves that it can be done. The patient collapsed at a local farmers festival out in another county, the bystanders immediately called 911, the paramedic arrived and started assessing the patient and treating him, he then passed on what he was finding, we took his info and prepped our treatment room, then once he got here we made sure to activate and get him to the cath lab asap. The patient had a 99% distal RCA blockage that was treated with a stent, he was doing fine that night. The two other nurses and I made the comment of how smooth it went, the cardiologist came as quickly as he could along with the cath lab team, EMS helped us get him in and get him going, and the flow chart went without a hitch on treatment, and the patient did quite well, we had his pain from a 9 out of 10 down to a 2 out of 10 by the time they took him to cath lab.
Things we can improve on, EMS activation of cath lab, somehow get a cardiologist and cath lab team in house 24 hours, EMS treatment in the field since we can have long transport times. The problems we face is we will probably never have an in house cath lab or cardiologist, we're not a teaching hospital and don't have enough patients for that. EMS activation, well it is a problem with the different technologies. We have x, the county ambulance has y, and the fire department/city ambulance has z, and they won't talk to each other without the different companies fixing it (which they want to charge a lot for!). The paramedic will be able to send us real time ECG from the field soon (if we get it straightened out), so we may be able to start field treatment protocols too! I would love to set down Fire, EMS, RN's, and Doc', along with Cath Lab and Cardiologist, and explain to the medical equipment manufactures where they are screwing up and slowing us down! Then again I think the technology side does it on purpose to make us buy more shit.
BTW the national average is greater than 90 mins, that is why the AHA is pushing the door to balloon time of less than 90 mins.
Ottawa times were pretty good but we all are looking at ways to do better. I can't find the latest on Seattle, have to check on it.
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