BASE HOSPITAL GROUP ONTARIO Chapter 3 for 12 Lead Training -WHY 12 LEAD- Ontario Base Hospital Group Education Subcommittee 2008 TIME IS MUSCLE.

Slides:



Advertisements
Similar presentations
Patient Oriented Therapy for STE-MI
Advertisements

Degli Studi e dei Registri: sul Territorio
Marek Kondys, MD Paweł Buszman, MD, FESC, FACC
STEMI Care Delivery Report Out
Door to Balloon Times: Achieving 90 Minutes and Less.
Reperfusion Strategies for ST elevation MI.
Inequalities across Europe in access to primary angioplasty to treat acute heart attack patients -the cross-border dimension- John Martin, MD, FRCP, FESC,
Local improvement following national clinical audit workshops Auditing heart attacks Saving lives Dr Andrew Wragg Barts Health.
BASE HOSPITAL GROUP ONTARIO Chapter 8 for 12 Lead Training -The 15 Lead ECG- Ontario Base Hospital Group Education Subcommittee 2008 TIME IS MUSCLE.
Ontario Base Hospital Group Education Subcommittee 2008
Part I: STEMI BootCamp The 5 “R’s” of Reperfusion”
Chapter 3 for 12 Lead Training -Precourse-
EMS and D2B in Pennsylvania Douglas F. Kupas, MD, FACEP Commonwealth EMS Medical Director Bureau of EMS PA Department of Health.
Regional AMI Care: Bridging the Rural Health Care Gap Darren B. Bean, MD University of Wisconsin Emergency Medicine/Medflight Director UW Level 1 Heart.
Chattanooga/Tristate Region STEMI Update 2014 C. Samuel Ledford, MD Chattanooga Heart Institute.
Regional Systems of Care to Optimize Timeliness of Reperfusion Therapy for STEMI: The Mayo Clinic Protocol Henry H. Ting, MD, MBA Associate Professor of.
BASE HOSPITAL GROUP ONTARIO Chapter 4 for 12 Lead Training - ACS Assessment: History and Exam- Ontario Base Hospital Group Education Subcommittee 2008.
Current and Future Perspectives on Acute Coronary Syndromes Paul W. Armstrong MD AMI Quebec Montreal October 1, 2010.
STEMI: What’s the Rush? STEMI: What’s the Rush? William Phillips, MD, FACC, FSCAI Director of Cardiology CMMC A PCI Center perspective.
Quality Improvement in the Emergency Department Creating the culture so it’s second nature Jonathan A. Edlow, MD Associate Professor of Medicine Harvard.
Acute Coronary Syndromes Clinical Care Standard An introduction for clinicians and health services.
Bill Koenig, MD Medical Director Los Angeles County EMS Agency.
Very Rapid Treatment of STEMI: Utilizing Pre-Hospital ECGs to Bypass the Emergency Department Kenneth W. Baran, MD Medical Director for United Hospital’s.
Improved Care for Acute Myocardial Infarction Linking Referral and Receiving Centres – How can We Communicate Better? Dr. James McMeekin AMI Faculty Cardiologist,
Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc. Chapter 53 Management of ST-Elevation Myocardial Infarction.
Masoudi FA et al J Am Coll Cardiol (Published online 27 November 2008) CVN Weekly Interventional Update December 8, 2008 Jeffrey J. Popma and Christopher.
GUSTO I GUSTO I Median Time (hrs) Between Symptom Onset and Treatment GUSTO III GUSTO III InTIME II InTIME II ASSENT.
The Heart of the Matter A Journey through the system of care.
Around-the-Clock Primary Angioplasty: A Process of Care Analysis Comparing Off-Hours and Normal Hours Treatment of Acute STEMI R Leung, D Lundberg, D Galbraith,
GP IIb/IIIa Inhibition in STEMI: Growing Clinical Trial Evidence.
Welcome Ask The Experts March 24-27, 2007 New Orleans, LA.
ACS and Thrombosis in the Emergency Setting
AMI Strategy How to Achieve Door-to-Balloon Times of 90 Minutes and What to Do Next? Aaron Kugelmass, MD Director, Cardiac Cath Lab Associate Division.
MD DM DNB FACC FICC FCSI FESC LAKSHMI HOSPITAL, PALAKKAD.
Ambulance Victoria and MonashHEART Acute Myocardial Infarction (Mon-AMI) 12 lead ECG project. An update On behalf of the MonAMI Team A Hutchison, Y Malaiapan,
The Impact of Regional ST-Elevation Myocardial Infarction Systems of Care on the Use of Protocols and Quality Improvement Initiatives in Community Hospitals.
Role of Percutaneous coronary intervention (PCI) after thrombolytic therapy By Dr. Mohamed Mahros Assistant lecturer of cardiology Benha faculty of medicine.
Management Of AMI Does time matter?? What is the best strategy: PPCI Vs TT.
National AMI Information Call February 5, 2008 Patient Safety Initiative.
Which Early ST-Elevation Myocardial Infarction Therapy (WEST) Trial Paul W. Armstrong, WEST Steering Committee Published in The European Heart Journal.
Myocardial Ischaemia National Audit Project Are we replacing good fibrinolytic treatment with poor primary PCI? John Birkhead who has NO CONFLICT OF INTEREST.
Prehospital ECGs for Acute Coronary Syndromes Summary and Comment by Aaron E. Bair, MD, MSc, FAAEM, FACEP Published in Journal Watch Emergency Medicine.
Acute Coronary Syndromes SIGN 93. MINAP Mortality after Acute Coronary Syndromes Cumulative: 13.6% Blue 10.6% Green 11.6% Red.
West Hertfordshire Primary Angioplasty Service Masood Khan.
The Health Roundtable Saving heart muscle by reducing delays to getting patients to the overnight regional catheter lab Presenter: Debby Hailstone Middlemore.
False Positive ST Elevation in Patients Undergoing Direct Percutaneous Coronary Intervention David M. Larson MD, Katie M. Menssen, BS,, Scott W Sharkey.
Presenter Disclosure Information Kevin Daniel, RN, CEN Clinical Data Supervisor Northside Hospital System Metro Atlanta Mission Lifeline Quality & Data.
Chattanooga/TriState Regional Update 2015 Robert L. Huang, MD MPH UT Erlanger Health System.
Dr Martyn Thomas Kings College Hospital Primary angioplasty “A UK Experience” “The UK experience”
RACE: Reperfusion of acute myocardial infarction in North Carolina emergency departments Christopher Granger, MD Director, Cardiac Care Unit Duke University.
Acute Myocardial Infarction February 8, 2006.
Date of download: 6/2/2016 Copyright © The American College of Cardiology. All rights reserved. From: 2007 Focused Update of the ACC/AHA 2004 Guidelines.
High-risk ST elevation MI patients (>4 mm elevation), Sx < 12 hrs 5 PCI centers (n=443) and 22 referring hospitals (n=1,129), transfer in < 3 hrs High-risk.
No conflicts of interest or financial ties to disclose.
Overview of the Winnipeg CODE STEMI Project Implemented May 2008 Dr.J.Tam MD, FRCP(C), FACC Section Chief Cardiology WRHA and University of Manitoba Lillian.
Relationship of the TIMI Myocardial Perfusion Grades, Flow Grades, Frame Count, and Percutaneous Coronary Intervention to Long-Term Outcomes After Thrombolytic.
Challenges in Pre Hospital Diagnosis & Management of Acute MI
Telemedicine To Expedite Patient’s Transfer: The Introduction of the Videophone Lowell Satler, MD Washington Hospital Center.
Arch Intern Med. 2007;167(1): doi: /archinte Figure Legend:
Chapter 5 for 12 Lead Training -Making sense of the 12 Lead-
Optimising STEMi Care- Role of Nurses and Paramedics
The Association between Prehospital Time Intervals and ST-Elevation Myocardial Infarction System Performance.
Management of ST-Elevation Myocardial Infarction
Eva Kline-Rogers RN, NP, AACC University of Michigan
ASSENT-3 PLUS 1,639 patients with STEMI Treatment Group A
Brief History on Mission: Lifeline
STEMI-INITIAL PRESENTATION TIMING 2013 ACC/AHA GUIDELINES
Figure 1 PCI strategies in patients with STEMI and multivessel disease
American College of Cardiology Presented by Dr. Michel R. Le May
A model of variation and accelerating factors in the process of acute care chain of patients with STEMI going for primary PCI. PCI, percutaneous coronary.
Presentation transcript:

BASE HOSPITAL GROUP ONTARIO Chapter 3 for 12 Lead Training -WHY 12 LEAD- Ontario Base Hospital Group Education Subcommittee 2008 TIME IS MUSCLE

OBHG Education Subcommittee WHY 12 LEAD REVIEWERS/CONTRIBUTORS Neil Freckleton, AEMCA, ACP Hamilton Base Hospital Jim Scott, AEMCA, PCP Sault Area Hospital Ed Ouston, AEMCA, ACP Ottawa Base Hospital Laura McCleary, AEMCA, ACP SOCPC Tim Dodd, AEMCA, ACP Hamilton Base Hospital Dr. Rick Verbeek, Medical Director SOCPC 2008 Ontario Base Hospital Group AUTHOR Greg Soto, BEd, BA, ACP Niagara Base Hospital

OBHG Education Subcommittee With appreciations… This educational material could not have been developed with out the assistance of materials and wisdom provided from and shared by the following sources:  Tim Phelan: 12-Lead ECG in the Acute Coronary Syndromes  Bob Page: 12-Lead ECG for Acute & Critical Care Providers  The many paramedics who, through their experiences and sharing, became the teachers of the developers of this curriculum.

OBHG Education Subcommittee Chapter 3 Objectives  Describe why most EMS systems introduce PHECG  List the mortality for AMI  Define reperfusion for AMI  List the methods available for reperfusion  Discuss the causes of delay in reperfusion for AMI & prehospital role in reducing delays  List the AHA Guidelines 2005 recommendations for prehospital role in ACS

OBHG Education Subcommittee Introduction & Purpose  Prehospital 12 Lead ECG (PHECG) is one of the fastest growing new additions to prehospital care in North America  12 Lead ECG provides advantages over traditional 3 & 4 lead ECGs commonly used by prehospital providers for rhythm interpretation  #1 most common reason for acquiring and interpreting 12 Lead ECG in the field is faster reperfusion for AMI patients

OBHG Education Subcommittee PHECG & Reperfusion  Acute Myocardial Infarction (AMI) is the most frequent cause of death in the developed world  Mortality is estimated at 50%  AMI = coronary artery occlusion (thrombus)  Problem: death of myocardium beyond thrombus  Modern treatment for AMI = reperfusion

OBHG Education Subcommittee Reperfusion for AMI  Reperfusion involves opening up blocked coronary artery to restore blood flow to affected myocardium  Methods of reperfusion: 1.Pharmacological – administration of thrombolytics (fibrinolytics) that breakdown clot 2.Mechanical – balloon angioplasty referred to as Primary Percutaneous Coronary Intervention (PCI) that mechanically opens artery

OBHG Education Subcommittee Timing of Reperfusion

OBHG Education Subcommittee Time is Muscle  Survival from AMI is all about time!  Regardless of method (thrombolysis or PCI), early reperfusion therapy has been demonstrated to improve survival and quality of life for AMI patients.

OBHG Education Subcommittee Reperfusion Delays in AMI 1. Delays from onset of symptoms to patient recognition – 60 to 70%. 2. Delays in out-of- hospital transport – 5% 3. Delays in in-hospital evaluation and treatment – 25 to 30%

OBHG Education Subcommittee Prehospital Role in Reperfusion Three current strategies:  PHECG + ED notification for early in-hospital thrombolysis  PHECG + prehospital thrombolysis  PHECG + prehospital triage to Cath lab for Primary PCI

OBHG Education Subcommittee Vancouver Edmonton Ottawa Nova Scotia Calgary Victoria Simcoe County Kitchener Prehospital STEMI Care A Canadian Track Record

OBHG Education Subcommittee PHECG & Reperfusion  Prehospital 12 Lead ECG has been demonstrated to improve time to reperfusion for a select group of at risk patients - ST-Elevation Myocardial Infarction (STEMI)  Multiple published trials: PHECG in conjunction with early ED notification has been associated with improved time to ED diagnosis and early thrombolysis for STEMI from 10 – 60 minutes. (Source: see references)

OBHG Education Subcommittee AHA Guidelines 2005 American Heart Association recommendations on out-of-hospital 12 Lead ECG:  Implementation of prehospital 12 ECG  PHECG & advance notification of ED for out- of-hospital patients w/ S&S of ACS  STEMI patients: completion of a “fibrinolytic checklist”  Door-to-needle time in ED of < 30 min  Door-to-balloon time in cath lab < 90 min

OBHG Education Subcommittee Next Step: Prehospital Role in Reperfusion  Various EMS systems in North America and Europe have evolved prehospital strategies for managing reperfusion: Prehospital Thrombolysis: the delivery of fibrinolytic agents (associated with earlier symptom to treatment time) Prehospital triage for in-hospital Primary PCI

OBHG Education Subcommittee Percutaneous Coronary Intervention (PCI)

OBHG Education Subcommittee Stent

OBHG Education Subcommittee PCI with STENT

OBHG Education Subcommittee Le May MR et al. N Engl J Med 2008; 358: D2B times for direct transfer to PCI center vs referral from ED Referred directly from field Referred from emergency department p value Median door- to-balloon time (min) 69123<0.001 Door-to- balloon time less than 90 min (%) <0.001

OBHG Education Subcommittee Ontario Base Hospital Group – Medical Advisory Committee 2007 Recommendations to MOHLTC: 1. Prehospital 12 Lead ECG become a Provincial standard for all ambulances and paramedics. 2. MAC supports introduction of prehospital strategies demonstrated to improve early reperfusion in STEMI: a) Early ED notification (i.e.: STEMI Alert) b) Prehospital Thrombolysis c) Prehospital Triage for Primary PCI

OBHG Education Subcommittee Why 12 Lead  Other than for reperfusion…  The following case illustrates the importance of obtaining a 12 lead early in the patients care. Credit and thanks goes to Tim Phalen for the use of these slides

OBHG Education Subcommittee Case Presentation  Chest Pain for 2 hours  4 on a 1-10 scale  12-lead obtained with the first vitals  Oxygen and nitroglycerin given  Next 12-lead eight minutes later

OBHG Education Subcommittee First 12 Lead

OBHG Education Subcommittee 8 Minutes later

OBHG Education Subcommittee Value of an Early ECG  ECG changes from ACS are dynamic  MONA treatment may mask changes  ST elevation = reperfusion indication  EMS is in a privileged position Early 12-lead During symptoms Before medication

BASE HOSPITAL GROUP ONTARIO QUESTIONS?

BASE HOSPITAL GROUP ONTARIO Well Done! Education Subcommittee STARTQUIT