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    Reperfusion Therapy For STEMI (beta)

    Official guideline from the American College of Emergency Physicians.

    Summary by Eric Steinberg, DO
    Strength
    Level A
    Level B
    Level C

    Recommendations

    Fibrinolytics for Delayed PCI
    1. Fibrinolytics may be administered to patients when door-to-balloon (D2B) time is anticipated to exceed 120 minutes.
    2. A dose reduction should be considered when administering fibrinolytics to patients aged 75 years or older.
    Transfer to PCI Center
    1. To decrease the incidence of major adverse cardiac events (MACE), patients with ST-segment elevation myocardial infarction (STEMI) should be transferred to a percutaneous coronary intervention (PCI)-capable hospital as soon as possible.
    Opioid Use
    1. Because safety has not been established, clinical judgment should be used in deciding whether to provide or withhold morphine in patients undergoing reperfusion therapy.
    What do the icons mean?  
    Research PaperPromes SB, Glauser JM, Smith MD, et al. American College of Emergency Physicians. Clinical Policy: Emergency Department Management of Patients Needing Reperfusion Therapy for Acute ST-Segment Elevation Myocardial Infarction. Ann Emerg Med. 2017;70(5):724-739.