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STEMI Management (CPG A0408)

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***STEMI*** / ***ACUTE MI***

  • Transmit 12-lead ECG

  • Request Advanced Paramedic

  • Treat as per CPG A0401 Acute Coronary Syndrome

  • If symptoms > 12 hrs, continue management as per CPG A0401 and transport with notification.

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Symptoms < 12 hrs

Consider time to PCI and PHT Inclusion/Exclusion criteria

Time to PCI > 1 hr AND
Time to PCI < 1 hr OR
All inclusion criteria met AND
Not suitable for PHT
No exclusion criteria met
Treat as per Prehospital thrombolysis below
Treat as per Urgent transport to PCI below

  • The time to PCI is measured from when STEMI is identified by a PHT endorsed and equipped paramedic

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Prehospital thrombolysis

  • ALS paramedics MUST call cardiology consult service (CCS) prior to thrombolysis

  • Advanced paramedics MUST call CCS where any relative C/I are present

  • IV access x 2, Normal Saline TKVO

  • Complete checklist and read information statement to Pt

  • Tenecteplase IV bolus (see table below)

  • Heparin IV bolus 4000 IU

    • Repeat Heparin IV bolus 1000 IU at 1 hour intervals

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  • Capture a repeat ECG 30 minutes prior to arrival and transmit with notification

  • Aim to transport the patient to the closest PCI facility (in consultation with the Clinician).

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Urgent transport to PCI

  • Paramedics must call CCS if there is any uncertainty regarding STEMI diagnosis or thrombolysis, including if paramedic believes monitor interpretation to be incorrect where Pt may be eligible for PHT

  • ALS paramedics MUST call CCS prior to administering Heparin

  • Do not delay transport

  • Heparin IV bolus 4000 IU

    • Repeat Heparin IV bolus 1000 IU at 1 hour intervals

  • Capture a repeat ECG 30 minutes prior to arrival and transmit with notification

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Further notes

  • If a 12-lead ECG identifies a potential STEMI and the patient is eligible for thrombolysis, but the paramedic believes the monitor's interpretation of the ECG is incorrect, the cardiology consult service must be contacted.

  • If distance or resourcing precludes travel to a PCI centre as the primary destination, consider the following in consultation with the Clinician:

    • MEDEVAC to a PCI centre OR

    • Tx to an emergency department that can provide temporary care for the thrombolysed Pt until they can be transferred to a PCI centre

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Flow Chart

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