From Scott Weingart EMCrit Interview: Who needs the Cath Lab now??

Who Needs the Cath Lab/Cards Consult?Here is the podcast of Scott's Interview with me . (some of this gets distorted in MS internet explorer)FirstActivate the Lab for unambiguous STEMI (only clear STEMIs have a 90 minute CMS mandate)Get Cardiology or Interventional Consultation for more complicated cases: difficult ECGs, subtle ST elevation, ST depression with ongoing symptoms, STEMI "Equivalents.This requires a systematic approach, with buy-in from Cardiology, that they will respond immmediately to such requests for help.  What do they get out of it?  Fewer false positive activations and more activations for the subtle cases that need it.--Know that the ACC/AHA guidelies for NonSTEMI recommend less than 2 hour cath for: 1) ACS with refractory ischemia and 2) ACS with hemodynamic or electrical instability.Proviso: Many cardiologists do not understand these subtle ECG findings or pseudo-STEMI patterns.  You must be a strong advocate!  If you are worried, get serial ECGs, compare with an old ECG, and get a high quality contrast echocardiogram exam.  Persistentocclusion of a significant epicardial coronary artery will nearly always have a wall motion abnormality if the echo quality is good, is done with contrast, and is read by an expert.I. ACC/AHA Criteria ST-elevation at the J point in 2 contiguous leads that reaches the following thresholds:1Men less than 40 years of age: 2.5 mm in V2-V3 and 1 mm in all other leadsMen greater than 40 ye...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs