Our Chest Pain protocol is based on measurement of Troponin T and CKMB(mass)
at 12 hours after the onset of symptoms, not timed from admission. I know
that some will disagree with this as it may involve actually taking a
history from the patient. It does allow an assessment to be made earlier, on
average, even though the assays are batched (6 am and 4pm) to reduce costs.
We have noticed that some patients show an increase in CKMB ahead of the
rise in TnT so beware of making discharge decisions on the basis of early
TnT results. It seems prudent to hang onto patients until a confident risk
categorisation has been made, even if installing defibrillators in all the
carparks might be cheaper.
A "nearby hospital" once had to radio a taxi to turn around and bring a
patient back after the results of the markers were incorrectly anticipated
by a bedless and desperate admitting team. I can imagine the conversation at
the taxi depot "I had a TnT of 2.5 in the back of my cab today..." "Oh Yeah?
I heard the ones between 0.100 and 0.250 are just as bad"
*************************************
Dr RDG Neely
Department of Clinical Biochemistry
North Durham Healthcare NHS Trust
Dryburn Hospital
Durham DH1 5TW
Tel. 0191 3332440 Fax. 0191 3332679
*************************************
-----Original Message-----
From: Philip Hyde [mailto:[log in to unmask]]
Sent: 31 October 2000 09:00
To: [log in to unmask]
Subject: Discharge of chest pain patients from A/E
I have had a query from our A/E Consultant regarding early assessment and
potential discharge of patients with chest pain. We use a single sample
taken at > 12 hours for troponin T as our sole cardiac marker strategy (we
can't afford to do one on admission as well...yet) and his contention is
that he cannot afford to wait for > 12 hrs to elapse as he has no beds. He
wants strategy for all his A/E staff to follow to avoid admitting all such
patients and clogging the system up. Notwithstanding members feelings about
impatience, medicolegal issues, I wondered what, if anything, other
laboratories may have agreed with their A/E Depts (as opposed to MAU's -
ours are ecstatic with trop T).
Philip Hyde,
Consultant Clinical Biochemist,
Pilgrim Hospital,
Boston (UK).
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