Download The Heart of the Matter - Brattleboro Memorial Hospital

The Heart of the
Matter
A Journey through the system of care
Introductions
Brian Richardson
Director of Emergency Services at BMH
Emergency Room
Preparedness
Emergency Medical Services Liaison/Quality Assurance
Paramedic
George Terwilliger
Emergency Department Medical Director
MD over 25 years of experience
Denial, not a river in Egypt
• Median 2 hour delay in
calling 911 (Meischke et
al.)
• Symptoms would go
away
• Symptoms not severe
enough
• Did not think of calling
911
• Proximity to hospital and
thought 911 would delay
treatment
• Only 65% of women said
they would call 911
Don’t wait call 9.1.1
• Call 9.1.1 at the
onset of symptoms
• Follow the dispatcher
instructions
• Do not drive yourself
to the hospital
• Stay calm and try to
relax
Emergency Medical Services
• In Vermont the EMS system is staffed by licensed, credentialed
providers
• Large amounts of educational resources are directed towards
training these professionals in the area of Acute Coronary
Syndrome
• Transporting services have at a minimum, the basic tools to
recognize and begin treatment for a patient experiencing a
heart attack.
• Statewide protocols for Vermont EMS professionals provide a
foundation of best practices for care of a patient with Acute
Coronary Syndrome.
• Brattleboro Memorial Hospital works in conjunction with
Rescue Inc to provide quality assurance and case review for all
cases involving Acute Coronary Syndrome.
What to expect from EMS
• Pre-arrival instructions
from the dispatcher
• First Responders
• An ECG
• History, which equals a
lot of questions
• An exam
• Perhaps medications
• Safe but rapid
transport
En-route to the Hospital
• Cardiac monitoring
• Intravenous lines
• Additional ECGs
• Vital sign monitoring
• Additional
medications
• Early
communications with
the hospital
Once you arrive at the hospital
• You are taken
immediately to a
treatment room
• An ECG is done
• Perhaps another IV
• Blood samples drawn
• Additional questions
are asked
• Treatment decision s
are made
Treatment pathways
• Always approached
from the worst case
first
• Heart Attack
• Unstable Angina
• Low to Intermediate
risk for Acute Coronary
Syndrome/Chest pain
pathway
• Risk and benefits of
treatments are always
discussed
Heart Attack (STEMI)
• With ECG changes, lab
biomarker changes and a
potential for significant
damage
• Consultation with and
arranging for transport to a
catheterization lab for
percutaneous coronary
intervention
• Assessment for the
appropriateness of using
clot busting agents
• Use of those agents, if
appropriate within 30
minutes of your arrival in
the Emergency
Department
Unstable Angina/non-STEMI
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High risk factors identified
Positive ECG findings for an oxygen starved heart
Positive lab results (immediately or over time)
Consult with cardiology
Admission or transfer to a higher level of care
Low to Intermediate Risk
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Low to Intermediate Risk factors
Other potential causes eliminated or reduced
No changes on serial ECGs
No changes to serial lab tests
May be observed in the Emergency Department (6 hours or
greater)
May have a consultation with cardiology
May be admitted to a monitored bed in the hospital
Stress test either done at discharge or scheduled shortly after
follow-up with a cardiologist scheduled
Factors for prevention may be discussed by the Emergency
Department Physician
Our Goals
• To give you the best possible patient experience
• Weigh risks versus benefits in diagnosis and treatment
decisions
• To educate and inform so that you may make the best decision
for your healthcare
• To treat you with respect and compassion
QUESTIONS