Due to the large amount of important information contained in our ACLS algorithms, a printable PDF download link is available below.
Fibrinolytic therapy is the treatment of choice for STEMI patients who meet specific criteria:
Patient has been symptomatic (Chest pain) for longer than 15 minutes but less than 12 hours.
ECG is diagnostic for ST elevation indicating an MI or a new Left Bundle Branch Block.
If any of the following are present, consider transfer to a PCI capable facility
Heart rate over 100 per minute in the presence of a systolic blood pressure less than 100 mm Hg
Presence of signs that might indicate pulmonary edema (e.g., rales)
Cool and clammy skin that might indicate shock
Contraindication to administration of fibrinolytics as listed in #4 below
If any of the following are present, fibrinolytics are contraindicated
Systolic blood pressure over 180 mm Hg
Diastolic blood pressure over 110 mm Hg
Difference in systolic pressure more than 15 mm Hg between the right and left arm
History of structural CNS disease
Any significant head or face trauma in the previous 90 days
Major trauma, surgery or gastrointestinal or genitourinary bleed in the last 6 weeks
History of bleeding or clotting disorders
CPR has been implemented for more than 10 minutes
Pregnancy in a female
Any serious chronic disease such as liver or kidney disease or advanced cancer