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STEMI ALERT
Apply Patient Sticker Here
Physician Checklist
Date ED Attending
ED Resident
Patient Name
Site: Johnstone Memorial
Check Determine that STEMI is occurring as verified by ECG done in (circle one)
boxes • ED
• Transmitted via PHTL (pre-hospital 12-lead)
• Transmitted via fax (urgent care center)
Immediately notify secretary that a STEMI ALERT is in progress
Direct secretary to open a STEMI ALERT Packet
Please Obtain following history from patient (or EMS) if possible.
have this • How long as the pain been going on?
info for • Primary doctor and / or cardiologist
cardiologist • Coumadin use?
-it may • History of dye or contrast allergy?
impact tx • History of prior MI / stent / CABG / renal failure?
• Age and DNR status
• CPR, intubation or multiple defibrillations in route?
Review cath lab activation criteria on back of this sheet
Y? N? Is this an uncomplicated STEMI that meets criteria for ED activation of the cath lab????
****** If “Yes” activate cath lab immediately. Don’t wait to talk to the cardiologist!
**The ED attending (not resident or staff) must talk directly to the operator to activate!
Page the correct cardiologist:
• If the patient has a cardiologist, use that group
• If they don’t, but their PCP has a cardiologist listed in the referral base, use that
cardiology group
• If they are uncovered (or there is confusion) use the on-call group.
Make sure the interventional cardiologist calls back w/in five minutes. If not, re-page them.
Order medications using Acute MI Medication Order Sheet. Check boxes. All STEMI patients
should be considered for the following unless contraindicated
• ** ASA -324 PO or rectal ** only contraindication is true aspirin allergy
• ** Beta-blocker -metoprolol 25 mg PO (preferred) or metoprolol 5mg IV x3, ** hold for
contraindications such as hypotension or hypoxia
• Heparin 60 units per kg, no max dose IV bolus x 1
• Integrilin 180 micrograms per kg, IV bolus x 1
Avoid hanging drips please!
**If aspirin and/or beta blocker are not given, clearly document why (JCAHO req)
If cath lab is ready and patient is stable, send patient to cath lab when lab calls
Please keep family updated, assist in consent, make sure patient is prepped for lab
Help complete Data Sheet A and Data Sheet B
The nurse will contact you when cath lab is ready for patient. You must OK patient leaving for
lab. Best practice is to go to cath lab or send resident. You reserve right to hold patient in ED.
Do so only in very unstable pts; stable pts can go. Call 12680 to update lab if you can’t go.
Return this form to the STEMI scribe. Sign here:
Comments on back of this form, please!

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