Action by physicians and other health-care professionals in hospital emergency departments

Abstract

Advances in the management of acute myocardial infarction can significantly improve outcome, primarily through highly time-dependent coronary reperfusion and successfully resolving early complications. Effectiveness of treatment is now more limited by delays in reperfusion and number of patients who receive coronary reperfusion than available therapy. Specific methods of decreasing the time to reperfusion and increasing the number of patients treated must be broadly applied to further reduce morbidity and mortality. Facilities that manage myocardial infarction should be classified according to capabilities to promote emergency transport to the nearest facility offering definitive care, generally, thrombolysis or urgent PTCA. Standardized evaluation and treatment protocols are critical in providing rapid and optimum care. Essential protocols include questionnaires for thrombolysis candidacy and diagnosis triage; critical initial management pathways; patient management algorithms; and standardized orders for thrombolysis, anticoagulation, and initial coronary care admission.