Checklist for Fibrinolytic Therapy
Checklist at a Glance
- The fibrinolytic checklist is a convenient way for the team leader to quickly recall the indications and contraindications for fibrinolytic therapy.
- For ACS with symptoms that began > 12 hours before presentation to the ED, the clinician considers a PCI transfer.
- For ACS with symptoms that began < 12 hours before presentation to the ED, the clinician considers the administration of fibrinolytic after assessing for contraindications and risk.
Goals for the Fibrinolytic Checklist
The clinician will:
- Understand the importance of timing in the checklist.
- Understand the use of ECG findings to determine the patient’s appropriateness for fibrinolytic therapy.
- Understand relative and absolute contraindications for the use of fibrinolytic.
Box 1: Timing of Symptoms
If the patient’s ACS symptom duration is > 12 hours, they are outside the window for fibrinolytic therapy, and the clinician considers a transfer for PCI. If the symptoms began < 12 hours before presentation, the team proceeds to Box 2.
Tissue plasminogen activator(tPA) is a type of fibrinolytic that breaks up blood clots.
Box 2: ECG Findings
The team leader evaluates the patient’s ECG and makes a diagnosis.
If the 12-lead ECG shows a STEMI or new left bundle branch block (LBBB), the team proceeds to Box 3. If STEMI or LBBB is not apparent, the checklist is discontinued.
TA 12 – lead ECG evaluates the heart’s electrical activity
Box 3: Contraindications to Fibrinolytic Therapy
The clinician answers each question to ascertain whether fibrinolytic therapy may be contraindicated. If the answer to any of the questions is yes, the clinician must use their best clinical judgment to determine if the team should proceed to treatment.
If the benefits of fibrinolytic outweigh the risks, the team proceeds to Box 4.
Box 4: Is the Patient at High Risk?
The team determines the answers to the following questions:
- Is the heart rate > 100 bpm and SBP < 100 mm Hg?
- Does the patient have symptoms of pulmonary edema?
- Does the patient have signs or symptoms of shock?
- Are there other contraindications to fibrinolytic therapy?
If the answer to any of these questions is yes, the team proceeds to Box 5. Otherwise, they proceed with the administration of fibrinolytic.
Box 5: Considering Transfer to a Cardiac Catheterization Lab for PCI Therapy
If the patient is NOT a candidate for fibrinolytic therapy, the clinician considers transferring the patient to the in-house cardiac catheterization lab or to a hospital with those facilities. The team must not delay PCI therapy if it is available.
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