Challenging Case Presentations From South Texas Methodist Hospital REGIONAL SYSTEMS OF CARE DEMONSTRATION PROJECT: MISSION: LIFELINE™ STEMI SYSTEMS ACCELERATOR
Case 1 65 y/o female with sudden onset of sub-sternal chest pain at 11PM EMS called. On arrival offers to transport to non-PCI capable facility 30 minutes away. Husband declines and drives patient to free standing ED On arrival 11:36 pt ECG c/w acute inferior STEMI ED physician notifies cardio-hospitalist, transmits ECG, while the patient is being loaded for transport
ECG on arrival to ED
Hospital Course Pt arrived to PCI capable facility at 12:20 and taken directly to cath lab Initial balloon inflation at 12:38 D2B from ED 62 minutes Total ischemic time 98 minutes
Cardiac Cath
Cardiac Cath
Cardiac Cath
Points of discussion Should EMS have even offered to go to a non- PCI capable facility? Should lytics have been given prior to transport? Would an EMS on site ECG changed the course or even expedited the care?