Fibrinolytic therapy is the treatment of choice for STEMI patients who meet specific criteria:

  1. Patient has been symptomatic (Chest pain) for longer than 15 minutes but less than 12 hours.
  2. ECG is diagnostic for ST elevation indicating an MI or a new Left Bundle Branch Block.
  3. If any of the following are present, consider transfer to a PCI capable facility
    1. Heart rate over 100 per minute in the presence of a systolic blood pressure less than 100 mm Hg
    2. Presence of signs that might indicate pulmonary edema (e.g., rales)
    3. Cool and clammy skin that might indicate shock
    4. Contraindication to administration of fibrinolytics as listed in #4 below
  4. If any of the following are present, fibrinolytics are contraindicated
    1. Systolic blood pressure over 180 mm Hg
    2. Diastolic blood pressure over 110 mm Hg
    3. Difference in systolic pressure more than 15 mm Hg between the right and left arm
    4. History of structural CNS disease
    5. Any significant head or face trauma in the previous 90 days
    6. Major trauma, surgery or gastrointestinal or genitourinary bleed in the last 6 weeks
    7. History of bleeding or clotting disorders
    8. On anticoagulants
    9. CPR has been implemented for more than 10 minutes
    10. Pregnancy in a female
    11. Any serious chronic disease such as liver or kidney disease or advanced cancer
Summaries created by:
 Acls Certification Institute
Chest Pain Checklist for STEMI Fibrinolytic Therapy