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Cardiac Level One

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

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Cardiac Level One

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  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

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