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STEMI Protocol – Beating the Clock. Saving Lives.

It may begin as a tightness. Your chest, your back, your shoulders, neck and jaw one by one feel like they are tight, full, difficult to move in a way. It can also present as gastro pain, nausea. "It's indigestion." You think. It's something I ate, something didn't agree with me. But it doesn't go away. You feel faint, lightheaded, sweaty. "I'll just sit down and wait for the room to stop spinning."

What you may not realize is that all of these can be signs that you are having a heart attack.

At Memorial Hospital of Converse County our Emergency Department providers and staff are trained in a specific protocol: STEMI. STEMI stands for ST Segment Elevation Myocardial Infarction, basically a protocol specifically designed and implemented to help a patient having a heart attack.

What is the difference between a heart attack and cardiac arrest? The difference is like comparing a tremor to a full out earthquake. A heart attack indicates that there is a blockage of blood flow to the heart via one of the main arteries; this lack of oxygen rich blood causes a section of the heart normally fed by that artery to die or suffer damage. Cardiac Arrest is the full stopping of the heart from beating in total. Most heart attacks do not lead to sudden cardiac arrest. But when sudden cardiac arrest occurs, heart attack is a common cause.

The STEMI protocol provides for a crucial time for patients presenting with a heart attack. Once 911 is called, EMTs are dispatched to the patient where they are given an EKG. This EKG is transmitted real time to a Physician in the Emergency Room who can assess their status. Once it is determined the patient is indeed having a heart attack they are transported immediately to the Emergency Room.

Arriving at the hospital the staff is in constant communication that a STEMI patient is inbound and all are alert and ready to work together. "A lot of times we don't even take them off the stretcher, since that takes precious time." Stated Robynn Scheehle the head of MHCC's Emergency Department. Once at the Emergency Department , another EKG is performed within five minutes of their arrival. "Our goal is ten minutes, though we usually complete it in five."

"Everybody works fast on the patient. If they come in via ambulance they usually already have an IV going. We give them blood thinning medications like Brilinta or Heparin, in an effort to thin the blood clot causing the blockage to the artery, so we can basically stop the heart attack. Then we put the patient back on to the ambulance and they are on their way to the cath lab in Casper. We counted and we had seventeen heart attack patients present in the last calendar year, one and half in a month basically"

The STEMI protocol itself is established to lessen gaps of time between a patient presenting with symptoms of a heart attack and being stabilized and sent for further treatment in the cath lab in Casper. Time is ticking away for the heart muscle that needs to be replenished by blood so every second is accounted for and used to get blood flowing back through the artery.

Items like push to talk phones in admitting, which alert staff immediately when a patient walks in to the Emergency Department with chest pains all the way to the aforementioned EKG transmitters, all do their part to lessen gaps of communication and heighten the immediacy of patient care. As well the communication between hospitals and departments is crucial in handing off patients. Establishing that there is a STEMI patient inbound from Douglas as well allows the staff at Wyoming Medical to be prepared to receive the patient and take them immediately in for procedure in their cath lab. This inter-hospital communication and work has proven crucial to meeting and exceeding expectations for servicing the patient's health.

Between Memorial Hospital of Converse County's Emergency Department and Wyoming Medical Center's cath lab they have an established goal time of 2 hours. This time includes travel time to the patient if they call 911, preliminary EKG, travel time back to the Emergency Room, setting up an IV or other necessary items like oxygen, load off the ambulance, administering of blood thinning medications, loading back on to the ambulance, travel time to Casper, then rolling the patient immediately into the cath lab for a stint procedure with the staff on call and ready, the stint procedure there and out into recovery. All of these are completed routinely within the two-hour mark, even besting it at times by more than thirty minutes.

"The fastest we've had someone in and out of the Emergency Room is nine minutes," beamed Scheehle, who is rightly proud of the accomplishments of her team. "As soon as we hear 'Chest Pain' coming over those PTT phones, everyone is just right on it. I mean they all gather at the bedside and it's just game on. It is like a challenge for us, but it's always the best interest of the patient. The sooner we can get them to the cath lab the sooner we can stop that heart attack, and the faster you do that the less heart damage you get. And that is what we want to avoid, heart muscle damage."

Catching these symptoms early your heart is helped long term in its heart attack state. Receiving proper medical care, blood thinners, then a stint procedure that opens up the artery and allows the full completion of blood flow back into that area of the heart, all the while being monitored by highly trained personnel lessens damage to your heart, or the need further procedures. Time is crucial and heart attack symptoms shouldn't be shrugged off or ignored. Cardiac arrests, full stoppage of the heart, are often the result of heart attacks.

"Seconds are crucial; every second we can knock off, the better for the patient. " Concluded Scheehle.

If you or someone you know exhibits symptoms of a heart attack:

  • Chest Pains or Tightness
  • Arm/Shoulder/Jaw/Back Pain
  • Indigestion
  • Sweating
  • Faintness or Dizziness

Do not delay in seeking care by calling 911. The sooner they receive medical support the better their prognosis.