TN: Mission Lifeline STEMI Protocol for Primary PCI First Medical Contact to PCI goal is < 90 minutes for direct presenters and < 120 minutes for transfer patients

1
TN Mission Lifeline STEMI Protocol for Primary
PCIFirst Medical Contact to PCI goal is lt 90
minutes for direct presentersand lt 120 minutes
for transfer patients

• Activate referral PCI hospital and transport
  service (EMS or Air)
• Monitor, Oxygen, IV access
• Nitroglycerin 0.4 mg SL (repeat as needed or IV)
• Aspirin 325 mg po chew swallow
• Clopidogrel (Plavix) 600 mg po
• Heparin 60 units/kg IV bolus (max 4000 units)
• Morphine sulfate IV as needed for pain
• Attach hands-free defibrillator pads, prefer
  radiotransparent
• Transfer to PCI hospital
• Door-In to Door-Out goal is lt 30 minutes

2
TN Mission Lifeline STEMI Lytic
ProtocolRecommend lytic therapy when First
Medical Contact to PCI is anticipated to be gt 120
minutes and Symptom onset is lt 4 hours

• Activate referral PCI hospital and transport
  service (EMS or Air)
• Monitor, Oxygen, IV access
• Nitroglycerin 0.4 mg SL (repeat as needed or IV)
• Aspirin 325 mg po chew swallow
• Clopidogrel (Plavix)
• Age 75 years 300 mg
• Age gt 75 years 75 mg
• Lytic agent (PICK ONLY ONE)
• TNKase OR Retavase
• lt 60 kg 30 mg 10 unit bolus over 2 minutes
  followed by 2nd 10 unit bolus 30 minutes later
• 60 69 kg 35 mg
• 70 79 kg 40 mg
• 80 89 kg 45 mg
• gt 90 kg 50 mg
• Heparin 60 units/kg IV (max 4000 units) bolus,
  then 12 units/kg/hr infusion (max 1000 units/hr)
• Morphine sulfate IV as needed for pain
• Attach hands-free defibrillator pads, prefer
  radiotransparent
• Transfer to PCI hospital