Introduction
Title
Learning Objectives
Why Do We Care About Remote and Rural Cases?
What is Remote and Rural?
Scotland Remote and Rural Demographics
Who Lives Remote and Rurally?
Case
Mr MacKay 1
Mr MacKay 2
Likely Diagnosis?
Differential
MI Epidemiology
Symptoms
Diagnosis
High Sensitivity Troponin
What Investigations are we Able to do for Mr Mackay in a Rural GP Practice?
ECGs
ECG 2
ECG 3
Mr MacKay's ECG
Mr MacKay's ECG 2
Gold Standard Management - NICE Guidelines
PCI
Thrombolysis
Contraindications to Thrombolysis
PCI or Thrombolysis?
Immediate Management in Rural GP Practice
Travel Options
Ambulance or Helicopter?
Complications of MI
Social Factors
Resources and Feedback
Resources
Feedback
Management of the Medical Patient in Remote & Rural Location
Gold Standard Management - NICE Guidelines
Click to work your way through the flow chart.
Clinical Diagnosis of STEMI
Offer Aspirin (300mg) unless
have taken already within 24hrs
Is presentation within 12hrs
of symptom onset?
Yes
No
Can PCI be given in <120mins of the
time that fibrinolysis could be given in?
Have symptoms resolved?
Yes
No
Yes
No
1. Activate PCI pathway
2. Offer 1 of Clopidogrel,
Prasgruel or Ticagrelor
3. Take to CATH lab for
coronary angiography
+/- PCI if indicated
4. Offer Heparin or
Bivalirudin
Offer fibrinolysis with
antithrombin
Consider angiography / PCI
Consider angiography / PCI
Consider angiography / PCI
Consider angiography / PCI
Consider angiography / PCI
Consider angiography / PCI
Consider angiography / PCI
Consider angiography / PCI
Offer thrombolysis +
medical therapy
ECG 60 - 90mins after
fibrinolysis
Residual ST elevation?
No residual ST elevation?
Offer immediate angiography - DO NOT repeat thrombolysis
Consider angiography in same hospital admission or more urgently if recurrent myocardial ischemia
See the
NICE Guidelines ACS treatment algorithm
.
