The 4 Ds of STEMI Survival

The 4 Ds of STEMI Survival

Door

·         EMS personnel should transport a patient with a suspected STEMI directly to a PCI capable hospital

·         Door to needle time is 30 minute

·         Door to balloon time less than 90 minutes

·         High risk patients in cardiogenic shock transferred within 30 minutes

Data

·         Time of onset of symptoms

·         Obtain targeted history

·         Obtain 12 lead

·         Obtain VS

·         Review fibrinolytic check list

·         Obtain labs

·         Obtain PCXR

Decision

·         Risk stratification for fibrinolytics

·         Fibrinolytics recommended for patients with Sx < 12 hours

·         Fibrinolytics recommended for patients with evolving MI over 12 hours

·         Consider transfer before fibrinolytics if PCI can be performed within 120 minutes of first medical contact

·         Consider transfer for patients in cardiogenic shock

·         Consider transfer for failed reperfusion after fibrinolytic therapy

Drug

·         Door to needle time is 30 minute

o   Limit infarct size

o   Prevent life threatening arrhythmias

o   Avoid and manage CHF

o   Treat life-threatening complications

·         Adjunctive drugs

o   Aspirin: 162- to 325-mg loading dose

o   Beta-Blockers:  IV or PO to manage dysrhythmias

o   Clopidogrel: 300-mg loading dose for ≤75 years of age, 75-mg dose for patients >75 years of age

o   Nitroglycerine:  SL, PO, or IV

ACLS for Experienced Providers

AHA 2013