Question#: 495

Question:

Hi, a question about Stemi bypass. Scenario, Pt presents with weakness and nausea. No c/p, no sob. Pt is hypotensive 70/50 and bradycardic at 50. GCS 15, 02 sat 93%, temp 37.3, Blood gluc 15.1. First responder presents you with a 12 lead that shows st elevation in 2, 3 ,avf with reciprocal changes. Further 12 lead ecg's will show elevation in lead 3 only. This pt never had any c/p. no tightness, no funny feeling. Should this pt be transported to the closest er or Stemi bypass to HI. The stemi bypass says chest pain or equivalent consistent with cardiac ischemia/ mi.

Thanks for your input. Dan Pollock

Answer:

Hi Dan,

Great question, we apologize for the delay in replying to your message.

In this case, the patient had “atypical” symptoms with an ECG qualifying for STEMI plus hemodynamic changes i.e. hypotension.

The nausea and weakness, in this situation, should be considered signs of cardiac ischemia or infarct.

The STEMI bypass criteria under question is: "experience chest pain or equivalent consistent with cardiac ischemia or myocardial infarction"

In this case the hypotension, bradycardia, nausea and weakness meet the "equivalent consistent with cardiac ischemia or myocardial infarction." Therefore, this patient should be transported as a code STEMI and the bypass would apply unless the patient becomes more severely compromised (impending CPR, intubation etc.).

Based on your question we are going to explore additional curriculum in spring CME that expands on our understanding of "or equivalent consistent with cardiac ischemia."

Regards,

QPS