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The Need for Regional Integrated Care for ST-Segment Elevation Myocardial Infarction

2011; Lippincott Williams & Wilkins; Volume: 124; Issue: 7 Linguagem: Inglês

10.1161/circulationaha.110.012617

1524-4539

John P. Vavalle, Christopher B. Granger,

Mechanical Circulatory Support Devices

A 57-year-old man suffered a sudden cardiac arrest at home, witnessed by his son, who called 911 and began cardiopulmonary resuscitation immediately.Emergency medical services (EMS) were activated and arrived on the scene within 10 minutes.The patient was found to be in ventricular fibrillation and was defibrillated 5 times by EMS.He was intubated in the field, and an ECG revealed inferior STsegment elevation.The Reperfusion of Acute Myocardial Infarction in North Carolina Emergency Departments protocol was initiated.He was transported across county lines, past a non-percutaneous coronary intervention (PCI) hospital, directly to a PCI facility, where the preactivated catheterization laboratory was awaiting arrival (Figure 1).On presentation, he was comatose with a pulse of 90/min, blood pressure of 90/ 70 mm Hg, and had pulmonary edema with distant heart tones.Case 2 presentation: A 76-year-old man was driven by his family to his local emergency department after having 1 day of worsening shortness of breath and 2 hours of substernal chest pain.On arrival to this non-PCI facility, he was found to be in respiratory