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Reperfusion Therapy, Cardiac, Emergency Medicine

Shamai A. Grossman and Joshua J. Solano Reviewed 06/2017
 


Basics

Description

  • Cardiac reperfusion therapy is required on patients that present with ST-segment elevation myocardial infarction (STEMI)

  • Early percutaneous coronary intervention (PCI), but not fibrin...

Diagnosis

Signs and Symptoms

  • Chest pain, heaviness, or pressure feeling

  • Shortness of breath

  • Arm, neck, or back pain

  • Weakness or fatigue

  • Nausea, vomiting

  • Diaphoresis

  • Palpitations

  • Dizziness or syncope

  • STEMI ECG

Essential Workup

Treatment

Pre-Hospital

  • IV access

  • Oxygen

  • Cardiac monitoring

  • Sublingual nitroglycerin for symptom relief, unless use of phosphodiesterase inhibitor in the last 24 hr

  • Aspirin 162 or 325 nonenteric coated

  • Local...

Follow-Up

Disposition

Admission Criteria

All patients being considered for reperfusion therapy should be admitted to a cath lab or transferred to a PCI center or admitted to tele bed or an ICU setting 

Discharge Criteria

Pearls and Pitfalls

  • Goal of reperfusion therapy is primary PCI within 90 min of 1st medical contact. Transfer to a PCI-capable facility when this window can be accomplished or assess for fibrinolytics...

Additional Reading

  • American College of Emergency Physicians; Society for Cardiovascular Angiography and Interventions, O’Gara  PT, et al. 2013 ACCF/AHA guideline for the management of ST-elevation myo...

Codes

ICD9

410.90 Acute myocardial infarction, unspecified site, episode of care unspecified 

ICD10

I21.3 ST elevation (STEMI) myocardial infarction of unspecified site 

SNOMED

  • 401303003 Acute ST segment e...

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