Name…………...…...

Surname…………………
STEMI Clinical Pathway Date of Birth………………………………………
HN……………………...AN……………………..

Screening Nurse / Registration officer found signs and symptoms of STEMI :

Chest pain  Discomfort at chest area  Sprain at shoulder Sprain at jaw Epigastrium pain
Tired easily  Weakness  Fatiqued Acute Hypotension Cardiac arrest
Date ……………………………....time of Symptom……………………………....arrival time………………………………..

***Check Contraindication for anti-platelet ,

anticoagulant and fibrinolysis Transfer patient to ER
1. History of hemorrhagic stroke
2. History of nonhemorrhagic stroke in 1 year
3. Intra Abdominal Hemorrhage
V/S ……………………..  O2sat……………... pain score…………….
4.Recent major trauma / surgery in 4 weeks
EKG12 Lead ( Start time to EKG …………….……... )
5. Aortic dissection
Risk stratification: GRACE risk score………………..
6. Refractory Hypertension ( SBP> 180 mmHg )
Lab: CBC, BUN, Cr, Electrolyte
7.Thrombocytopenia / current use of
Troponin T
anticoagulants : the higher INR ( warfarinINR
Anti-HIV
> 2)
CXR
8. Resuscitation than 10 minutes
On oxygen Keep sat.95 %
Check contraindication for anti-platelet , anticoagulant and fibrinolysis***
9. Pregnancy
R/O STEMI : Consult Cardio (Start time to consult ………………….)
 ASA…………………….................. ( Start time …………….....)
 Plavix…………………....................( Start time ………………..)
 UHF………………………......……..( Start time………………...)

EKG Show

STEMI
-ST elevation NSTEMI
-New LBBB

Primary PCI Fibrinolysis

Start Anti-platele Check contraindication for Fibrinolysis

ASA gr V 1 tab oral Start…………….. Chest pain ≤ 12 hours
 Plavix 600 mg oral Start…………….. Fibrinolysis Drug………………………….
 UFH Abciximab  Eptifibatide Admit CCU
………………………………………..
 Inform Consent for PCI
 Admit CCU Failed reperfusion

Primary CABG Medical

PCI Therapy Reference : WP-PCT-002-00