EMS Protocol of the Week - Suspected Myocardial Infarction (Adult)

Diaphoretic? Clutching your chest? Might just be your excitement for another EMS-PoW, but it might also be a heart attack! Hard to tell, I know, so it’s probably just safer to call 911.

When dealing with a suspected MI, EMS will administer 324mg of aspirin orally, starting at the CFR level. BLS providers will immediately request ALS backup, but importantly, if the nearest ALS unit is farther away than the nearest appropriate hospital, BLS will instead transport the patient for further evaluation. If the patient is already prescribed nitroglycerin, BLS can help the patient to take it (assuming no erectile dysfunction meds have been given in the preceding 72 hours), but they do not have their own to give. 

Once ALS is on scene, they will perform and interpret a 12-lead EKG – this will assist in determining whether it is more appropriate to bring the patient to the nearest hospital or to bypass said hospital for the nearest STEMI/PCI center. En route, they can also administer their own nitroglycerin for persistent chest pain (again, assuming no ED meds, as well as a systolic BP > 100mmHg).

Not a lot for you all to do on the OLMC phone, but keep in mind that the decision for closer hospital vs longer transport to STEMI center is the main reason behind EMS calling for these sorts of cases. Listen closely to the case details, as well as the paramedic’s description of the EKG (if they have not sent it electronically) to help answer that question.

See you all next week for more! www.nycremsco.org or the protocols binder to tide you all over until then!

 Dave