Chest pain + no ST elevation + ANY location + positive enzymes = NO
thrombolysis.
Thrombolysis has only been shown to be of benefit in the presence of
strictly defined ECG criteria, relating to ST segment elevation and/or
bundle branch block.
These were described in great detail (along with the supporting evidence) in
the May issue of the Annals (Anonymous. Clinical policy: critical issues in
the evaluation and management of adult patients presenting with suspected
acute myocardial infarction or unstable angina. Annals of Emergency Medicine
2000;30(5):521-544).
This is one of the best cures for insomnia I have ever come across.
Although the idea of blood testing patients en route (particularly where
journey times are long) makes an interesting topic of discussion, I would
personally prefer to get pre-hospital ECGs and thrombolysis sorted out for
the straightforward Q wave infarctions before embarking on the evaluation of
non-specific chest pain in the back of a moving ambulance.
In addition, the Best Evidence Topic "clinical bottom line" appearing in the
last issue of our own esteemed journal stated that "Troponin T is not
sensitive enough to rule out myocardial damage in the first 12 hours after
onset of chest pain" (JAEM 2000;17;213), suggesting that patients with
potentially cardiac chest pain may need to be assessed and investigated over
a longer period than the four hours mentioned by a previous contributor.
Jonathan Benger.
SpR, Bristol.
----- Original Message -----
From: Iain McNeil <[log in to unmask]>
To: <[log in to unmask]>
Sent: Friday, June 09, 2000 5:47 PM
Subject: Re: cardiac enzymes
> Chest pain + no ST elevation + rural location + positive enzymes =
> prehospital thrombolysis?????????
>
> Some ambualnce services (even urban ones) do well to get patient to
hospital
> in under 45 minutes from call.
>
> Just a thought!!
>
> Iain
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