SGCMH ED Delivers rapid response to STEMI patients

1/21/2016

The death rate from coronary heart disease has dropped 38 percent in a decade. One reason is that hospitals of all sizes have streamlined emergency treatment, and have slashed the time it takes to clear a blockage in a patient’s arteries and get blood flowing again to the heart.
“Think of the heart as the engine of our body. The coronary arteries are three blood vessels, much like the fuel lines of a car engine which carry blood to the heart tissue, just as fuel lines carry fuel to the engine of your automobile ” explained Dr. Matthew Bosner, Cardiologist and Director of Cardiology Services at Ste. Genevieve County Memorial Hospital (SGCMH). “A decrease in blood flow to heart tissue resulting in the death of heart muscle cells is called --a heart attack.” The primary cause of a heart attack is the result of a blood clot in a coronary vessel. “
All heart attacks are serious, but one type is the most dangerous of all and it’s known as a STEMI, ST segment elevation myocardial infarction. Dr. Bosner said its severity is defined in part by the outcome of an electrocardiogram (ECG).
“With an ECG we measure the electrical activity from the heart measured on the surface of the body,” Dr. Bosner explained. “The ECG can give us insight on how the heart is functioning. Research has demonstrated that an elevation of the ST segment strongly corresponds to a potentially significant level of damage inflicted on the heart muscle. The higher the ST segment, the more likely a greater region of decreased blood flow to a region of heart muscle. STEMI, as it’s called, is a very serious condition that must be recognized quickly, accurately, and a treatment plan rapidly implemented.”
The common phrase that’s used is “Time is Muscle.” A heart attack is a time dependent disease. The faster the diagnosis is made and treatment initiated the greater chance of an improved outcome. At SGCMH, Dr. Bosner explained that extensive evidence based protocols have been instituted when a patient presents to the Emergency Department with symptoms suggestive of a heart attack --namely chest pain, shortness of breath, fatigue, weakness and sweating.
STEMI is one of the primary Time Critical Diagnoses adopted by the State of Missouri. Individuals bring patients to the closest facility irrespective of the diagnosis. Ambulances are trained to triage patients with time critical diagnoses such as stroke or STEMI, to the closest DESIGNATED diagnosis specific facility so time is not wasted and the specific treatment can be instituted immediately.
“When a patient presents to our ED with heart attack symptoms,” said Dr. Bosner. “Our goal is to immediately bring the patient back to a room and have an ECG completed within 10 minutes and immediately evaluated by a physician. If there is a STEMI concern, policies and procedures are immediately initiated including, blood tests to confirm the diagnosis by blood enzyme analysis. If it is a STEMI, we make preparations (i.e. intravenous lines in place; all records copied; ECG results sent electronically, etc.) to transfer the patient to a facility that has a cardiac catheterization suite for a procedure to open up the blocked artery. This all takes place within 30 minutes of their arrival at SGCMH.”
The goal is to have the necessary coronary intervention between 90-120 minutes from “door to balloon,” explained Dr. Bosner. The clock starts when the patient enters SGCMH to the minute the interventional cardiologist is able to open the blockage in the artery and restore blood flow to the heart in the receiving hospital, commonly Missouri Baptist Medical Center.
“It’s very important to make a rapid and accurate diagnosis and treat a heart attack as quickly as possible,” he stated. “Time is muscle. The longer the heart muscle goes without oxygen, the greater the heart muscle damage. Learning the warning signs of a heart attack and what steps to take right away can save a life—perhaps your own.”
Bosner explained that after a heart attack patient is treated, their primary care provider and the SGCMH cardiology staff will continue to treat the patient locally.
“Patients enroll in the SGCMH cardiac rehab program and we continue to follow them here,” said Bosner. “We are very proud of the multidisciplinary, cardiovascular team we have assembled in our community. Together the primary care and cardiovascular physicians, respiratory therapy, nutritional therapy, cardiac rehab staff, home care, social service and case management, all strive to help patients in the recovery phase regain the physical and emotional strength to prevent a future event.”
“We have stringent evidence based protocols in place and have applied for Level 4 STEMI certification from the State of Missouri,” said Dr. Bosner. “This designation is reserved for rural areas, for facilities with demonstrated expertise to diagnose, stabilize and prepare patients for rapid transfer to a higher level of care.”
Dr. Bosner said the hospital was very excited that their application for Level 4 STEMI Certification was accepted.
“We are to undergo a site inspection on February 3, 2016 by cardiologists, emergency physicians and designees from the Missouri Department of Health,” he said. “We treat STEMI patients on a regular basis, but going through this certification process has been an enlightening educational process for all of us at SGCMH who care for STEMI patients. As medical director of this project I would like to thank everyone who has participated in carrying this project to the inspection stage, in particular Julie Kohm, RN and Laura Bailey BSN, RN and SGCMH Emergency Room director, who have truly carried this project on their shoulders.”

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