OVERHEAD PAGER: "CODE STEMI..."
"ER ROOM 2..."
"CODE STEMI..."
"ER ROOM 2..."
Code STEMI?!
That's an ST SEGMENT ELEVATED MYOCARDIAL INFARCTION!
This person needs help, and quick!
I'd better go!
Ok bud, while you and the code team
respond to that heart attack,
I'm gonna help these future nurses get their license
and maybe on a code team with me
not too long from now…
Seriously.
Now, the reason that code was called overhead
was probably because a patient showed up to the ER
with chest pain
trouble breathing
had a sweat going
and looking real real bad.
or maybe…
just a little pain her jaw.
So how do we know that it's a myocardial infarction
or a "Heart Attack?"
Remember "infarction" meaning tissue death
due to a blockage of blood flow
and myocardium meaning the heart's muscle tissue.
So, no blood is getting to some part of the heart
and that's a problem.
So, if a patient shows up to the ER with
any indication they might be having a myocardial infarction
The ER doc is going to order an electrocardiogram,
or an ECG or EKG
same difference
they both mean: electrocardiogram
The EKG is a paper print out of the electrical activity
in different parts of the heart
over the span of seconds.
Now reading EKGs ain't easy…
and that's the reason why doctors are the ones to say…
"Call a Code STEMI."
Because they've had much more training in reading EKGs
and even then, they talk to our wonderful Cardiologists
that have had extensive training in reading electrocardiograms.
"Hey heart doctor?"
"This is the ER doctor."
"I've got a patient here who's EKG looks like a myocardial infarction"
"But, you're the heart specialist, you tell me what you think.
Now, just because we have our ER docs, and hospitalists
and cardiologists floating around the hospital
doesn't mean we, as nurses, don't need to know
what a heart attack looks like
because it can strike at any moment.
Picture yourself on a telemetry floor
where all the patients are wearing cardiac monitors
with their heart rhythm showing on a screen
at all times.
Your patient just finished their chocolate boost and pureed peas
and they need hit the commode
and pronto.
So, you're in there with your gait belt
your air freshener and your clothespin
helping them transfer from the bed, to the commode.
Suddenly they start clutching their chest and saying
"Oh boy I feel weak."
"Ugh, it hurts to breathe!"
You're gonna glance up at the cardiac monitor
to see if there are any rhythm changes
and if there are
you've got some calls to make.
Because remember
as nurses we're the eyes, the ears
and the nose
kept on the patients, for the doctors, when they can't be there
which is the majority of the time.
So, while they don't expect us to know a cardiologist level
interpretation of an EKG
they do expect us to know the tell-tale signs
of a major event
like a myocardial infarction.
So, that's why on the NCLEX...
you're gonna see a question like this...
"The nurse is caring for a patient that suffered from a myocardial infarction."
"While monitoring the patient's EKG for signs of a myocardial infarction,"
"the nurse may observe which of the following?"
Now, I like to say "I" or "You" whenever I'm doing these questions
because it's gonna be me or you in this scenario, right?
Now I also like to "de-robotize" and "re-humanize" these questions
so they sound more real world
and less like those well-rehearsed BLS video scenarios.
Now I don't know if you're the type to say...
"Doctor…"
"while I was monitoring the patient's EKG"
"I observed signs that the patient might be"
"suffering from a myocardial infarction."
But that clearly ain't the way I talk
and that means, it ain't way I think..
Then I'll remove redundancies and carefully rephrase it
so, it's easier for my brain to compute.
"I'm carin' for a patient that's had a myocardial infarction."
"What am I gonna see on the EKG"
"that shows signs of an MI?"
That makes a lot more sense to me.
and here...
are your select all that apply choices...
I'll give you a few heartbeats to look them over…
:: lub dub… lub dub… lub dub… lub dub… ::
Alright, you got them all?
Good.
Now my doppelganger that ran off earlier
He gave you the first answer already,
and that is: "ST Elevation."
"ST Elevation" means the "ST" part, or "segment," of the rhythm is elevated.
hence the name STEMI.
ST, segment, Elevated Myocardial Infarction
Now, the ST elevation occurs when part of the heart ain't getting any blood
because one of the coronary arteries that supplies it
is completely blocked off.
And we all know what happens when tissue doesn't get any blood.
It dies.
Not good.
Correct choice number 2 is "Pathologic Q-wave"
Now you might say
"Ay! Nurse Stefan, wait a minute."
"Normal Sinus Rhythm has the Q-wave"
"What gives?"
and you betcha' it does.
And that's why Mother NCLEX threw in there
that IMPORTANT word: "pathologic"
"Pathologic Q-wave" means the wave was caused by a disease process...
this one being caused by myocardial tissue death.
Correct choice number 3 is "T-wave inversions"
This is yet another sign that could indicate myocardial injury or infarction
in this case, again, a full blockage of blood causing myocardial tissue death.
So, there are your three correct answers
but let's talk really quick about the three incorrect answers
and why they're not correct on the test.
The "U waves" are thought to be caused by
repolarization of the Purkinje Fibers or papillary muscles
which can be found in healthy patients
but also, may be a sign of electrolyte imbalances.
Not necessarily a MI.
Incorrect choice number 2 is "Prolonged PR-intervals"
which means slowing down of the signal
between depolarization, or "firing" of the atrium
and depolarization, or "firing" of the ventricle.
We'll see these prolonged PR-intervals, in first degree heart block.
And the last incorrect answer is "Irregular PR-intervals"
which can be thought of as inconsistent lengths of the PR-interval.
We'll see these irregular PR-intervals
in other types of heart block
like second, and third-degree heart blocks.
So for the purpose of the NCLEX
you should be connecting
"Myocardial Infarction EKGs"
to "ST Elevation"
"Pathologic Q-waves"
and "Inverted T-waves"
Now I remember this by saying
"Stefs a cutie."
Remembering that the Q and T waves
both have something unusual going on with them
and that mnemonic phrases
aren't always true at 6 in the morning.
CHILD: "ha-ha"
:: STRETCHER PASSING BY ::
They must be headed to the Cath Lab with that patient.
While I go help,
you keep studying so you,
can come join me.
Because all of these patients?
They need YOUR help.
Keep that in mind.
:: DING ::
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