STEMI – the role of the fellow.

You are rounding on a weekend, STEMI in the ED, more than likely you will be the first one on the scene to see the patient as most of the staff and interventionalist are at least ½ hour away. You should keep a few things in mind as your role:

1. Make sure the cath lab team is activated, call the operator just to see if all the calls went out.
2. Get a pertinent history from the patient about the event, when it started, quality, etc.
3. Make sure you get history about any bleeding problems in the past or planned surgeries in the future (if something big coming up soon, you may need to place a bare metal stent).
4. NEVER EVER EVER EVER hold up transport to the lab for any reason. Do not waste time getting right sided leads if the patient is about to go up, if you have some time, it would be a nice academic exercise.
5. Try to help the team to set the patient up on the table and get ready with your lead to get started. You do not want to be the last person in the room with your lead on, as everyone will be doing things and will not have time to help you get ready.
6. In the lab, try you best to stay out of the way and help when asked. More often than not, it is high stress environment and the artery has to be opened up ASAP, so the adrenaline is flowing.
7. Never ever let go of the wire, if you are asked to hold it in place. Just stare at it once it is between your hand and the table, glance at the monitor as well to make sure it is not moving, but do not let go.
8. After the case, always keep an eye on the groin and document it in the chart, with date and time.

A STEMI is a time to observe and take in everything happening around you, do not get too discouraged if you do not get to do a lot, you will in due time...