What is HOSPITAL criteria for a stemi?

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mrhunt

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strange question but hear me out. would love to Hear from RN's someone like that to weigh in if possible.

so we all know EMS criteria for a stemi.... but hospitals are, different? Were clearly just the dumb dumbs here. but you see contiguous ST elevations in 2 leads and theyre symptomatic in some way (or hell, even not) and its a stemi. (and i know one of you are gonna be like well ACTUALLY!! its blah blah, im just speaking in generals)

but my hospital just said a Stemi WASNT a stemi based on repeat negative troponins....despite multiple 12 leads having inferior Stemi / **STEMI ALERT** computer interpretation. and manual interpretation by ER Doc and Cardiologist agreeing with it. Pt was initially symptomatic with chest pain and dizziness but she sat waiting for acceptance for a transfer for over 24 hours so she no longer has chest pain or further symptoms.

So: Troponin negative
12 lead EKG positive and agreed upon by Multiple dr's, nurses and paramedics

but this pt was deemed to be NOT having an acute MI.....Why? a negative trop Cancels out ST Elevations in contiguous leads that are over 2mm?
When we bring in an acute MI to a stemi center (we, as in EMS) do they Hold off on a cath lab to wait for a troponin value to return?.....Cause the er's ive worked in have never done this. MAYBE an ISTAT but honestly dont remember if trops read on ISTATS or not...

Help me learn here.
 
Just fyi, they diagnosed her as "unstable angina" was her transfer diagnosis.
 
Negative troponin doesn't "cancel out" EKG criteria, but if ST elevation resolves, then that combined with the negative enzymes is where you get the dx of unstable angina vs. AMI. My guess is that's what happened, and she'll be referred to cardiology for a cardiac workup.
 
Where I'm at, we don't have a "STEMI" alert, we have a "CARDIAC" alert but effectively they're the same thing. If we see a STEMI on an EKG, that's an easy call. If one of our providers thinks there's a cardiac problem that would benefit from immediate Cardiology consult and/or immediate transfer to our PCI center, that's also a part of the CARDIAC alert. The CARDIAC alert also kicks off STAT labs and at least a chest xray, if not a few other tasks. We can usually get a PCI candidate transported out in about 30 minutes from when we call the alert.
 
ST elevation never resolved. In fact, hospital openly stated that elevations progressed and worsened for them. Never tombstones but was Enough to have my EMT partner who knows nothing about 12 leads immediately do a double take when he put on the 4 lead. It wasnt subtle. And it definitely never resolved on her EKG.
 
I have seen hospitals do that before (been 14 years when I worked private service last): Transferred a patient from a small hospital to a larger one with a cath lab, but they sat on her for 8 hours 1st because her Troponin levels were all good. They decided to transfer her to be evaluated at the larger hospital to see if she needed to have a Cath done or not (smaller hospital didn't even have a cath lab).
I called it in as a STEMI during the transport and we bypassed the ED (going there for evaluation) and went straight to the Cath Lab. The cardiologist invited us to stay and watch, and during the cath the small hospital called with the final Troponin's which were off the chart they were so high.
She ended up having open heart surgery, and cardiologist said she should have been transported 9 hours earlier.
 
Ekg changes occur outside of "interventionable" coronary artery dz. High inside curve balls include, for example, acute ascending aortic dissections that are only diagnosable thru CT scans...should someone think to get one.....it's pretty gratifying to "woulda, coulda, shoulda...after all the facts are in....make the call in the moment and get back to us....
 
E tank said:
Ekg changes occur outside of "interventionable" coronary artery dz. High inside curve balls include, for example, acute ascending aortic dissections that are only diagnosable thru CT scans...should someone think to get one.....it's pretty gratifying to "woulda, coulda, shoulda...after all the facts are in....make the call in the moment and get back to us....
Click to expand...
In re-reading that it looks like I was addressing the OP...I was not...that sentiment was generally expressed in frustration with after the fact criticism...guess I was feeling a little 'snake bit' that day.....no offense meant...
 
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