Emergency department evaluation and treatment of patients with ST-segment elevation myocardial infarction

Acute coronary syndrome (ACS) identifies a set of clinical presentations with a common etiology. This entity accounts for more deaths in the United States than any other disease or form of injury. Early identification and management has been shown to substantially reduce the morbidity and mortality associated with ACS. As a result of efforts by several organizations to inform the public of the importance of immediately responding to signs and symptoms of ACS, a growing percentage of ACS patients are seeking emergency department care in a timely manner. Patients with ST segment elevation myocardial infarction (STEMI) are among the most vulnerable ACS patients. Immediate triage to a properly equipped and staffed ACS area within the ED is essential. Some therapeutic measures can be implemented while the initial assessment is underway. Additional therapeutic interventions will be dictated by the results of history, physical examination, electrocardiogram, serum marker measurements, radiologic and ultrasound results. Protocols designed to assist with the management of STEMI patients improve the speed and accuracy of treatment while helping to reduce medical errors. Protocols should include stimuli that will encourage timely, appropriate interfacility transfers, personal physician involvement, and cardiology consultation. The rapid pace of advancement in medical knowledge surrounding STEMI management necessitates monitoring of compliance with protocols and periodic revision to achieve optimal outcomes for patients.