Prehospital Fibrinolytic Checklist
This figure is the Prehospital Fibronolytic Checklist, which consists of three primary steps and a series of “yes” or “no” questions. Step 1 contains the following question in a blue box: “Has the patient experienced chest discomfort for greater than 15 minutes and less than two hours.” If the answer is “No,” an arrow leads to a “Stop” sign. If the answer is “Yes,” an arrow leads down to another box that asks, “Does ECG show Stemi or new or presumably new LBBB?” If the answer is “No,” an arrow leads to a “Stop” sign. If the answer is “Yes,” an arrow leads to Step 2. It contains the following initial question in a blue box: “Are there contraindications to fibrinolysis? If any of the following [questions] is checked “yes,” fibrinolysis may be contraindicated.” A list of 10 yes-or-no questions follows under step 2.
- Systolic blood pressure greater than 180 to 200 millimeters of mercury or diastolic blood pressure greater than 100 to 110 millimeters of mercury?
- Right versus left arm systolic blood pressure difference greater than 15 millimeters of mercury?
- History of structural central nervous system disease?
- Significant closed head or facial trauma within the previous 3 months?
- Stroke greater than 3 hours or less than 3 months?
- Recent (within 2 two 4 weeks) major trauma, surgery (including laser eye surgery), G.I. or G.U. bleed?
- Any history of intracranial hemorrhage?
- Bleeding, clotting problem, or blood thinners?
- Pregnant female?
- Serious systemic disease (for example, advanced cancer, severe liver or kidney disease)?
- Heart rate greater than or equal to 100 beats per minute and systolic blood pressure less than 100 millimeters of mercury?
- Pulmonary edema (rales)?
- Signs of shock (cool, clammy)?
- Contraindications to fibrinolytic therapy?
- Required CPR?