부산대학교 도서관

In the United States, the average time between a patient's arrival in the emergency room (ER) and the administration of thrombolytic therapy for ST elevation and acute myocardial infarction (AMI) is over one hour. If the time to treatment (Rx) after arrival in the ER could be reduced by 30 minutes, it has been estimated that at least 5,000 lives could be saved annually in the United States. In our institution, the average time to Rx after arrival in the ER for ST elevation AMI from June 1991 to June 1993 was 71±32 minutes (median 64 minutes). We then developed an “AMI team” approach which included ER physicians, ER nurses, ECG technicians, and pharmacists. The diagnostic approach of the AMI team was based on two pocket cards that contained information on the following: 1) indications/contraindications of thrombolytic treatment in AMI; 2) thrombolytic treatment drug selection guidelines (tPA versus SK); 3) ancillary therapy drugs and dosages; and 4) ancillary therapy indications/contraindications. Treatment by the AMI team centered around an AMI kit-a tackle box that contained both thrombolytic drugs, all necessary ancillary treatments (ASA, heparin, beta blockers, nitrates, MS, and magnesium) and IV tubing plus drug compatibility charts. The time to Rx before and after institution of the AMI team was as follows: