ACS (Acute Coronary Syndome) in the Emergency Department

From Guide to YKHC Medical Practices

The diagnosis and management of ACS (Acute Coronary Syndrome) in the YKDHR Emergency Department has several peculiarities owing being 400 miles from the next highest level of care (Anchorage) and having limited inpatient capabilities for cardiac patients.


Inpatient Cardiac Services

  • The inpatient medical ward does not provide continuous telemetry monitoring and is not staffed by nursing with coronary unit experience.
  • The inpatient medical ward accepts patients with stable cardiac conditions or those who do not require continuous telemetry monitoring (such as CHF exacerbations, atrial fibrillation, etc.).
  • The inpatient medical ward cannot admit patients with ACS or with other conditions associated with a high risk for life-threatening arrhythmias.


PCI Availability

There are NO circumstances in which PCI could be available in 120 minutes. Even if a patient arrived with a STEMI while an Anchorage MedEvac crew were already present in the ED, the shortest time to PCI would be 2.5 hours (and that would be if EVERTHING occurred in the most optimum fashion, which is unlikely). In a more typical circumstance, the time from initiating transfer to PCI would be approximately five hours (if not six to ten hours, depending upon aircraft model, aircraft availability, etc).

Therefore thrombolytic therapy is the only re-perfusion option.


Disposition Options

Except in unusual circumstances, patients are not admitted to "rule-out MI." Patients undergoing an ACS work-up are either discharged to outpatient follow-up or transferred to a facility with a higher level of inpatient cardiac care.


Transfers

Beneficiaries

Urgent PCI required (typically for STEMI)
Beneficiaries requiring URGENT PCI are transferred to either Alaska Regional Hospital or Providence Alaska Medical Center.
NOT requiring Urgent PCI
Beneficiaries requiring a higher level of care but who will wait one or two days until angiography/PCI are transferred to ANMC (Alaska Native Medical Center).

Non-beneficiaries

All non-beneficiaries who require a higher level of care must be transferred to either Alaska Regional Hospital or Providence Alaska Medical Center.


ACS Guidelines

Date Guideline Revision Notes Status
06/22/2011 Guideline None Obsolete
12/02/2020 File:MI.pdf 2020 Revision Notes Active