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Assessment - Thrombolytic Screening Fo= rm (MI)

Clin= ical Indications:

= ______ 1. Susp= ected MI patients

Procedure:

= ______ 1.      Asse= ss and treat MI patients as per protocol

= ______ 2.      Thro= mbolytic screening forms will be completed for all suspected MI patients.=

= ______ 3.      Ther= e are twelve screening criteria on the form.

= ______ 4.      Scre= en for the following criteria:

= a.&n= bsp;      Pain lasting between 15 minutes and 12 hours=

= b.&n= bsp;      Systolic BP < 185 mmHg

= c.&n= bsp;      Diastolic BP < 110 mmHg

= d.&n= bsp;      < 15 mmHg difference in the right and left arm’s systolic pressure

= e.&n= bsp;      No history of CNS pathology

= f.&n= bsp;        No major surgery or other serious trauma within 6 weeks

= g.&n= bsp;      No bleeding or clotting problems and not taking b= lood thinners

= h.&n= bsp;      CPR < 10 minutes

= i.&n= bsp;        No pregnant or lactating females

= j.&n= bsp;        No serious systemic diseases

= k.&n= bsp;      No advanced or terminal cancer<= /p>
= ______ 5.      If a= ll of the thrombolytic screening criteria are met (all NO’s), alert the receiving facility of the

poss= ible thrombolytic candidate as early as possible.

= ______ 6.      All sections of the form must be completed.

= ______ 7.      The completed form will be attached to the signature sheet associated with the electronic PCR and

a cop= y will be left with the receiving facility.

Certification Requirements:

Succ= essfully complete a biannual evaluation including the indications, contraindications, technique, and possible complications of the procedure.

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