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STEMI Bypass with CPAP
Question# 960
STEMI Bypass and CPAP: At this time a contraindication for PCP to bypass STEMI to a PCI center is a patient on CPAP. If a patient is placed on CPAP and improving, is there a need for this bypass? It's hard to understand withholding definitive care for an improved protected airway. Can we patch to BHP for diversion?
Answer:
The Heart Institute is willing to take patients on CPAP who are not in severe respiratory distress however, as per the medical directive, the patient must be in severe respiratory distress to receive CPAP. If the patient is in mild to moderate distress or is showing signs of improvement with CPAP, then transport to the OHI may be appropriate; however, if the patient is in severe respiratory distress and not improving with treatments, transport to the closest emergency department to stabilize.
The specific PCP bypass condition of moderate to severe distress or CPAP is trying to manage the risk of respiratory deterioration during transport. UOHI has stated they are willing to accept patients who are on CPAP; however, if they are in moderate to severe respiratory distress, consider the risk of patient deteriorating while on route to hospital (i.e. the potential need for intubation). If the paramedics can manage the risk of respiratory deterioration and the benefits of transport to UOHI outweigh the risk of deterioration, UOHI is comfortable accepting these patients.
The BHP's are always happy and willing to take your phone calls/questions however, they are not able to override service specific bypasses as they can provide clinical guidance but lack operational oversight. Please feel free to also engage your superintendent/commander who can relay with CACC.
The specific PCP bypass condition of moderate to severe distress or CPAP is trying to manage the risk of respiratory deterioration during transport. UOHI has stated they are willing to accept patients who are on CPAP; however, if they are in moderate to severe respiratory distress, consider the risk of patient deteriorating while on route to hospital (i.e. the potential need for intubation). If the paramedics can manage the risk of respiratory deterioration and the benefits of transport to UOHI outweigh the risk of deterioration, UOHI is comfortable accepting these patients.
The BHP's are always happy and willing to take your phone calls/questions however, they are not able to override service specific bypasses as they can provide clinical guidance but lack operational oversight. Please feel free to also engage your superintendent/commander who can relay with CACC.