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Review Process
• Introductions • Background • Communication • Diagnosis • Care Provided • Hand-off of Patient
• Results • - times • - patient outcome • Barriers and
Opportunities • Conclusions • Follow Up Needed
Participants
• Patient • RN in Charge of Medic Tent at Scottish Games* • Mobile Care Ambulance Service • Chest Pain Center • Call Center • STAT RN • Cardiac Catheterization Lab * • Cardiologist* * Presenters
GHC Mobile Care Ambulance Service
• Mission: Transport GHS patients
• Mobile Care established in April of 1972 and is an affiliate of GHS UMC • Primarily inter facility, discharges and Referral Center transports • EMTs and Paramedics • Second highest transport volume in Greenville County; approximately
10,000 annually
• Mutual Aid Agreement with GC EMS • - Provides 911 ‘back-up’
• All ambulances ‘advanced life support’ staffed and equipped
MCAS Staff
• 30 Paramedics (8 CC EMT-P)
• 13 EMTs • 2 RNs • 2 in Nursing School • 11 also work for GC EMS or other 911 agencies • 9 also work for Fire Departments (3
Lieutenants and 1 Captain)
MCAS Medical Control • Martin E. Lutz, M.D.
• Medical Director, Emergency Services • Vice President Medical Staff
• Also Medical Control for:
• Greenville County EMS • GHS Med Trans (medical helicopter)
Mobile Care Crew John Reid, CC EMT-P
• EMT since 1998
• Works also PT for GC EMS
• CC EMT-P in 2010
• John also provided Medic coverage at 2010 Scottish Games, to Prince Edward
Mobile Care Crew Beth Smith, EMT-I
• EMT for 13 years • Started EMT career in New York • Fire Department – 6 years • Life Link at Roper St. Francis Hospital • Mobile Care • EMT –I 2009
Patient Chief Complaint, Symptoms and History • Patient: 60year old male • History • Family history of coronary artery disease • Sedentary lifestyle
• Chief Complaint • Chest Pain
• Symptoms • Chest pain since approximately 7:30 am; most severe in substernal area and radiating to left arm • Diaphoretic • SOB • Nauseated
Chest Pain Center Activates STEMI Alert
• STEMI activated via CPC; Dr. Crumpler at 10:36
• Play Recording
Mobile Care Ambulance Service Care Provided
• Oxygen initiated via nasal cannula • Cardiac monitor for ECG • Nitroglycerin, 0.4 MG • Peripheral IV initiated • Heparin • Taken to GMH Chest Pain Center 4
Mobile Care Ambulance Service Times
• 10:00 – Request received via radio • 10:06 – At patient • 10:22 – enroute to GMH • 10:37 – arrived at GMH
• 37 minutes from initial notification to arrival at GMH/Chest Pain Center
GMH Cardiology Stat RN • STEMI Role • - Meet EMS crew at ambulance bay/CPC or approach landing pad and assist with
patient transfer (training required). • - Receive brief report from flight/EMS crew regarding patient stability or changes
during transport • - Introduce self/role to patient and family; verbalize next steps and provide support • - Review and confirm pre-GHS meds given specific to AMI/cardiac cath • - Review targeted health history with patient, and biometrics pertinent to cardic cath
procedure • - Perform targeted assessment if time allows • - Assist with tracking times and documentation • - Support CPC/CC-ER, cath lab personnel, and cardiologist as required and within
scope of practice • - assist with patient transfer in CCU • Note: crossed trained for CCL for 2nd STEMI situations
Cardiac Cath Lab Team
• Dr. Josh Doll - Interventional Cardiologist • Beth Cook, RN – Circulator • Mary Sturges, RN – Circulator • Joelle Bridgesm RN - Scrub • Leigh Godbee-Stephens, RN, BSN -
Monitor • Gary Szeto, RN – Stat/STEMI RN
Cardiologist Carolina Cardiology Consultants
• Hometown: Batesville, Indiana • Area of Specialization: • Interventional Cardiology, Structural Heart Disease Therapies, Cardiac Pacing • College:
Indiana University, Bachelor of Science-Biology, Cum Laude, 1996 • Medical School:
Indiana University of Medicine, Doctor in Medicine, 2000 Residency: Vanderbilt University Medical Center, 2000-2003
• Cardiology Fellowship: • Medical University of South Carolina, Interventional Cardiology
Medical University of South Carolina, Cardiology
Cardiac Cath Vital Signs at 11:04 am
• Sp02 98%, HR 66, BP 118/69/76
• 11:02:59 – GMH Door Time • 11:03:00 – Greet/table • 11:11:54 – Case Start • 11:23:42 – Balloon
Procedure Performed
• INDICATION FOR PROCEDURE:
• Acute anterior ST-elevation myocardial infarction with occlude proximal LAD
• 1. Left heart catheterization with coronary angiography and left ventriculography
• 2. Percutaneous coronary stenting of the proximal left anterior descending
Cath Report Findings • Intervention
• Lesion is a complete thrombotic occlusion of the proximal LAD with TIMI-zero flow
• Conclusions
• Coronary disease with acute thrombotic proximal left anterior descending occlusion
• Successful stenting of the proximal left anterior descending with a bare-metal stent after aspiration thrombectomy
• Mild left ventricular systolic dysfunction