STEMI/STROKE BOOT CAMP “Time is Muscle” Paul T. Frantz, MD Medical Director, Cardiac Services Carilion Clinic.

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Presentation transcript:

STEMI/STROKE BOOT CAMP “Time is Muscle” Paul T. Frantz, MD Medical Director, Cardiac Services Carilion Clinic

Agenda “Time is Muscle” – what is the science behind this statement Case Reviews – with ‘take home’ messages Q & A

Full Disclosure Statement: Dr. Frantz receives no reimbursement from any of the companies or products sited in his presentation

Atherothrombosis: Thrombus Superimposed on Atherosclerotic Plaque Adapted with permission from Falk E, et al. Circulation ;92: Slide reproduced with permission from Cannon CP: Atherothrombosis slide compendium;

11 Treatment Delayed is Treatment Denied Antman EM et al. Circulation, 2004

Normal Right Coronary Arteriogram

Case # 1 “When all the stars are aligned” 54 y.o male with sudden onset chest pain before going to work Called 9-1-1, Fort Lewis crew responded c/o nausea, vomiting, right shoulder pain Cool and diaphoretic; BP 90/40 P 56 (weak) Loaded & IMI identified on 12 lead EKG Field Heart Alert called “ETA 10 minutes”

Field 8:04 AM

Time Sequence for Case # 1 Dispatched 7:52 Arrived at Scene 7:56 Arrived at Patient 7:57 Field EKG 8:04 Transport 8:07 Heart Alert Called (“ETA 10 min”) 8:23 Arrived at CCL (direct admit) 8:35 Balloon Time 9:01 Door to Balloon Time 26 minutes EMS Contact to Balloon Time 64 minutes

Cardiac Catheterization/PCI

Normal Left Coronary Arteriogram

Case # 2 “Reinforcing That Time is Muscle” 61 y.o. male (R.M.) c/o severe c.p. beginning about 4:30 PM Called after 5:00 and CPTS ground crew requested LG 10 on standby Clinical presentation and12 lead by ground crew suspicious for MI (rapid AF with wide complex QRS); LG 10 launched Given ASA, NTG, adenosine and fluid bolus Repeat 12 lead suspicious for MI and pt transferred to CRMH by air Remained hypotensive (100/72) with rapid, weak pulse during transport After evaluation in ED, Heart Alert called

CPTS 2nd EKG on ground CPTS 1st EKG on ground

LG 10 EKG while in air

Time Sequence for Case # 5 Standby Request for LG 1017:20 Launch Request17:55 Lift off17:59 Arrive at Scene18:23 Transport18:34 Arrive CRMH18:50 Arrived at ED19:00 Heart Alert called19:30 Balloon Time20:33 Door to Balloon Time93 minutes HA to Balloon Time63 minutes EMS Contact to Arrival CCL130 minutes

Cardiac Catheterization/PCI

41 Bottom Line………………… the old mantra rings true! System saves time! System saves muscle! Systems saves lives! System saves time! System saves muscle! Systems saves lives!

42 Treatment Delayed is Treatment Denied Antman EM et al. Circulation, 2004