1 / 20

Cardiac Level One

Cardiac Level One. Presented by: Jonna Bobeck BSN, RN,CEN. Objective.

nailah
Download Presentation

Cardiac Level One

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Cardiac Level One Presented by: JonnaBobeck BSN, RN,CEN

  2. Objective To provide a systematic approach toward providing an immediate coordinated response to the management of the Cardiac patient and to provide a definite standard of care; preventing any further cardiac injury in the hospital. (ACLS Certified RNs may initiate ACLS medication protocol.)

  3. Saving Time Save Lives • Many deaths due to lack of receiving lifesaving treatment • Timely treatment • A 2010 state law

  4. Definitions • STEMI –ST segment elevation myocardial infarction (Heart attack) • D2N – Door to Needle time (fibrinolytic) (goal <30 mins) • D2B – Door to Balloon time (goal <90 mins) • PPCI – Primary Percutaneous Coronary Intervention - balloon angioplasty

  5. Regional STEMI Network • A regional program developed for rapid treatment and timely transfer of patients with STEMI from the rural hospital to a PCI capable hospital using a standardized protocol

  6. Patient Population • STEMI - Anterior, Inferior, Lateral and True Posterior (Heart Attack) • New onset or unknown onset Left Bundle Branch Block patients- (LBBB) • Cardiac Emergencies- Cardiopulmonary arrest

  7. Currently in the US • 1.4 million heart attacks annually 400,000 STEMI • 30% of STEMI patients fail to receive PPCI or lytics (clot busting drugs) • Only 50% of patients who receive lytics have a D2N time of <30 minutes • Only 40% of patients who receive PPCI have a D2B time of <90 minutes

  8. ACC/AHA Guidelines • 12 Lead ECG < 10 minutes • Rapid STEMI identification • New or presumed new LBBB • Decision- Reperfusion strategy • PCI < 90 minutes Door-to-Balloon • Fibrinolytic > 90 minutes Door-to-Balloon • No contraindications • Chest pain duration < 2 hours • Goal: Door-to-Needle < 30 minutes

  9. Activation of Cardiac Level 1 • Criteria: ST elevation MI with onset of symptoms less than 12 hours • Recognize signs/symptoms of AMI • ECG < 10 minutes • If STEMI or New/presumed new LBBB • Activate • MedStar/transport agency • Cardiologist • And specify “Cardiac Level I”

  10. Interventions • Monitor, oxygen, 3 large bore IV • Aspirin • Plavix • TNKase IVP per weight as single bolus over 5 seconds or Retavase 10 units IVP x 2 doses 20 minutes apart • Heparin bolus: 60units/kg IV (max 4000 units) • Heparin infusion: 12 units/kg (max 1000 units/hr)

  11. Interventions • Nitroglycerin 0.4 mg SL, 1 tab q5 min x 3 doses, IV if needed for pain • Morphine sulfate as needed for pain • Attach hands free defibrillator pads • Portable Chest X-ray, send a copy with patient • Fax protocol sheet

  12. Roles • ED Triage/Charge Nurse/ICU RN • ED physician/Hospitalist/Attending • ED/ICU RN • HUC

  13. Roles Continued • Pharmacy • Respiratory Therapy • Lab • Clinical Coordinator

  14. Cardiac Level 1 Protocol Form • History & Physical • Checklist for medications • Data for performance improvement • Hand off transfer tool • MedStar • Cath Lab • Admitting

  15. Data & Medical History

  16. Level 1 Medications

  17. Back of Level 1 Form • Assistance with ECG interpretation • Fax and phone numbers of ED • Thrombolytic Indications and Contraindications • Post-thrombolytic guidelines

More Related