A lack of available Tenecteplase (TNK) could spell problematic
Every newsletter issue, we’ll be featuring an interesting ECG case. As a team of professionals involved in research and teaching, we believe that sharing cases is a great way to learn. All of these features are based on real-life experiences and cases, but key details are always changed while maintaining the educational facts. We’ve used a unique experience to illustrate the learning points for this select patient experience.
11:15: There is a phone call to the nursing station stating a patient was coming to them having a “heart attack”.
12:03: The patient arrives, groaning, complaining of chest pain and unable to walk.
12:14: The patient’s ECG reveals an inferior ST elevation. St. Boniface Hospital is called, and the CODE STEMI is initiated and connected to the nurse in charge. The ECG is reviewed, and STEMI is confirmed. Instructions are given to administer TNK (Tenecteplase). The nurse informs the CODE STEMI doctor that no TNK is on site. Only morphine, nitroglycerine, and oxygen is administered.
13:44 - 14:05: The patient twice suddenly becomes unconscious, both times the monitor shows ventricular fibrillation and both times the nursing staff successfully defibrillates the patient.
14:55: The nursing staff determine that TNK is available, however, they state they cannot administer this drug without a physician present on site.
18:30: Air transfer to St. Boniface is delayed due to weather issues.
04:16: The patient leaves the nursing station for air transfer to Winnipeg.
07:16: The patient arrives at triage at St. Boniface Hospital.
09:37: The patient arrives in the cardiac cath lab. The RCA is occluded. It is reopened and stented. The subsequent stay in hospital is uncomplicated. At discharge, echocardiogram reveals an EF 45-50%, severe RV impairment. Troponin peaked at > 10,000.
Conclusions
TNK is now available at all Federal and Provincial nursing stations.
Nurses can administer TNK when there is no physician on site. The ACS Network STEMI Algorithm details the indications, contraindications, and dosing regimen.
Always call the CODE STEMI doctor at St. Boniface (204-237-2053) when you have a patient with a STEMI.
