Project UPSTART: the Use of Procedural Standardization to Reduce Recognition to Repferfusion (R2R) Time in ST-Elevation Myocardial Infarction (STEMI)

Training Tutorial 1.7

Recognition: The First Key Step

To treat a STEMI, you must first detect it, right? But only an ECG that’s done can detect a STEMI. That seems obvious. But no ECG gets done by itself and the ED is always a busy place. In addition, patients presenting with STEMI often have atypical symptoms, so history and physical exam really aren’t that helpful. This combination is a potential disaster since we're often tempted to skip “just this one ECG!”

To help solve this problem, we designed the “UPSTART Screening ECG Protocol” (figure 6). To help solve this problem, we designed the “UPSTART Screening ECG Protocol” (Figure 6). Please review it carefully. It'll soon be displayed in your emergency department. Always obtain screening ECGs on patients that fit its criteria, even if you think they don’t need it. Sooner or later, you will have a patient who appears to be fine, but with an ECG that tells you otherwise.

Consistently obtaining screening ECGs is one of the most critical parts of the entire process. It’s your only defense against a missed STEMI and a possibly disastrous outcome! It’s an underappreciated, but critical responsibility.

Remember: When in doubt, do the ECG! Never rely on your clinical “guestimation” to determine who is having a STEMI.

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