New heart attack guidelines target lower risk patients
New heart attack guidelines target lower risk patients
Give patients immediate ECG
If you suspect a possible ST-elevation myocardial infarction (STEMI), get an immediate electrocardiogram (EKG). That's the key take-away message for emergency nurses from new guidelines from the American Heart Association/American College of Cardiology for stable and lower-risk patients.1
"Our recommendations for the initial treatment of STEMI continue to reinforce the goal of restoring blood flow to the heart as quickly as possible," said Elliott Antman, MD, chair of the guideline writing group. Antman is director of the Coronary Care Unit at Brigham and Women's Hospital and a professor of medicine at Harvard Medical School, both in Boston.
"ED nurses need to be very alert to the possibility that a patient with chest pain may be experiencing a STEMI," he says. "They should obtain a 12-lead ECG promptly in such patients, with a goal of doing so in under 10 minutes from the presentation of the patient to the ED triage area."
STEMI patients who present to hospitals without percutaneous coronary intervention capability may be candidates for transfer to another hospital, says Antman. "Expeditious transfer in such cases is key," he says. To cut delays, he recommends avoiding use of intravenous lines and infusion pumps that need to be switched over to different equipment systems.
At University of Illinois Medical Center's ED, a "10-minutes-to-ECG" rule is in place, says Alisa Murchek, RN, MS, associate director of nursing for the ED.
"What can occasionally trip us up is the patient population which presents with very atypical chest pain," says Murchek. "These are most commonly diabetics and women. We have had a patient present to the ED with a complaint of toothache that turned out to be having a STEMI."
It's mandatory for all University of Illinois' ED nurses to be certified in advanced cardiac life support, says Murchek. "This is absolutely necessary for the ED nursing population," she says. "It takes really good triaging and medical history taking to get to the bottom of some of these."
Ask patients about associated symptoms, such as shortness of breath and diaphoresis, and find out whether the pain seems to increase with exertion, Murchek says. "Sometimes the symptoms other than chest pain are what actually lead you to find the STEMI," she says.
Reference
- Anderson JL, Adams CD, Antman EM, et al. ACC/AHA 2007 guidelines for the management of patients with unstable angina/non-ST-elevation myocardial infarction. J Am Coll Cardiol 2007; 50:652-726.
Resource
The American Heart Association/American College of Cardiology (ACC) guidelines can be accessed at no charge on the ACC's web site (www.acc.org). Under "Quality and Science," click on "Clinical Statements." Scroll down to "Unstable Angina/Non-ST-Elevation Myocardial Infarction: ACC/AHA 2007 Guidelines for the Management of Patients With," and click on "Full Text."
If you suspect a possible ST-elevation myocardial infarction (STEMI), get an immediate electrocardiogram (EKG). That's the key take-away message for emergency nurses from new guidelines from the American Heart Association/American College of Cardiology for stable and lower-risk patients.Subscribe Now for Access
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