Would you activate the Cath lab or not?

[DrParasite]

We do activations all the time for strokes, STEMIs, trauma, etc, but those activations are always subject to override by the hospital.

As they should be; they have an MD after their name, and if they feel the need to override you, it's their call. But I would imagine they would only override you if it was clear that you were wrong

My protocols say I transmit any STEMI suspect, but the county next door has to transmit *all* 12 leads.

if the hospital wants to transmit all 12 leads, go nuts. it's a second set of eyes. I'm hoping they are transmitting (at least the suspected STEMI) it to the cardiology department, and not just to the regular ER. After all, you want an expert to review them....

They told us that too. Then they stopped activating on the word of EMS. If you can't or don't transmit, don't expect to go to cath lab around here.

Be wrong too many times, and the hospitals stop trusting your diagnosis (and I can't blame them for that either). Cry wold too many times and don't be surprised if your warnings get ignored. But transmitting a questionable 12 lead or calling for a consult should never be frowned upon, especially if you are just looking for confirmation to your conclusion.

My former NC agency bypasses the ER completely and takes the patient directly to the cath lab (on the EMS stretcher, we could actually watch them do the cath and see their rhythm return to normal).

When I was up in NJ, we could activate the CATH lab, but still stopped in the ER first, transferred the patient, and they brought them up stairs.

There needs to be a high level of oversight in cath lab activations, and if you are activating incorrectly, than you need to be sent back for retraining. Someone once told me that a paramedics knowledge of EKGs needs to be on par with a cardiologist, because they could be the first person to identity problems and initiate early intervention.

 

[jbiedebach]

I am always trying to learn and I accept the coaching to learn more about STEMI mimics, good advice. But I also think it matters what kind of system you work in. I have 6 cath labs in my immediate response area and they are all staffed during the day (3 are staffed 24/7). So I never "activate the cath" lab. If a patient is symptomatic and they have a suspected STEMI then I call a code STEMI. That means I transmit the EKG, the doc looks at it while en route, a lot of times they meet me at the door (there is one I go to most often, they are also our OLMC). Sometimes we go right to the lab, sometimes they go for bloodwork. If they are non-symptomatic but they have an iffy EKG, then I call it in, transmit it and tell the doc what is going on and we decide together what to do next. Like I said, I see elevation from BBB way more than BER so I have learned to call that out. Part of the reason I am on this forum is to get different points of view, but some of the advice given here doesn't reflect how my system runs- right, wrong or indifferent.


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[hometownmedic5]

"calling a code stemi" is functionally synonymous with "activating the Cath lab". There is still action being undertaken on your say so, you just aren't dragging people in from home.

 

[DrParasite]

I have 6 cath labs in my immediate response area and they are all staffed during the day (3 are staffed 24/7). So I never "activate the cath" lab.

yes, but if you call a code stemi, doesn't the cardiologist get involved? either physically going down to the ER to meet you at the door, or at least looking at the 12 lead? and if you have an emergency cath, they don't push off any prescheduled cath's to get them done, until your emergent one is completed? and if it's a night time call, do they call people in from home, or from other areas of the hospital (because few people have scheduled caths at 3am) to open and staff the cath lab?

Activating the cath lab (or throwing a monkey wrench into their routine operations) for a STEMI patient when they aren't a STEMI patient is wrong, a waste of resources, and makes you look like a fool who doesn't know his job, which reflects poorly on you, your agency, and EMS as a whole.

I'm not saying don't call s STEMI if you have a patient having a STEMI, I'm not saying don't speak to the Doc for a second opinion, and if it's questionable, then by all means call it (better to activate for a false positive than not call for a false negative). But if it's a known STEMI mimic, and you're activating the cath lab for a known mimic, well, your not helping anyone except those hospital personnel that are painting us as idiots who can't be trusted to do anything without a hospital employee verifying that what we are doing is correct.

 

[Tigger]

I am always trying to learn and I accept the coaching to learn more about STEMI mimics, good advice. But I also think it matters what kind of system you work in. I have 6 cath labs in my immediate response area and they are all staffed during the day (3 are staffed 24/7). So I never "activate the cath" lab. If a patient is symptomatic and they have a suspected STEMI then I call a code STEMI. That means I transmit the EKG, the doc looks at it while en route, a lot of times they meet me at the door (there is one I go to most often, they are also our OLMC). Sometimes we go right to the lab, sometimes they go for bloodwork. If they are non-symptomatic but they have an iffy EKG, then I call it in, transmit it and tell the doc what is going on and we decide together what to do next. Like I said, I see elevation from BBB way more than BER so I have learned to call that out. Part of the reason I am on this forum is to get different points of view, but some of the advice given here doesn't reflect how my system runs- right, wrong or indifferent.


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So if you can not call a STEMI with a BBB, why can't you do that with the other mimickers? There is no way to defend calling something over the radio a STEMI when it is not. Elevation is not the only criteria.