> I think the definitions of USA given on the list are all pretty valid
> (in
> that they are in widespread use). However, (as I think I have said
> before)
> from an A+E perspective are we INITIALLY really looking at putting
> people
> into risk categories as much asdiagnoses, and then
> investigating/treating
> according to risk. The risk category idea fits well with what people
> have
> said already.
>
> We would suggest 3 categories following initial assessment
> AMI (ECG criteria)
> High risk - features suggestive that this person should be admitted and
> sorted out
> e.g. LVF,
> significant deterioration in anginal symptoms (bit wooly as almost all
> IHD
> patients are in the ED because of some change)
> New (or not known to be old) ECG changes
> Low/Moderate - features that suggest that the person may be suitable to
> go
> home after ED assessment.
>
> USA as a definition may be best left as an exit diagnosis from the ED,
> or
> even just abandoned to the cardiologists.As has already been mentioned
> on
> the list new definitions of AMI may soon incorporate patients with small
> Trop rises, previously diagnosed as USA.
>
> Simon Carley
> SpR in Emergency Medicine
> Manchester Royal Infirmary
> England
> [log in to unmask]
> Evidence based Emergency Medicine
> http://www.bestbets.org
I take the point of what is being said about UA and I don't like the term either. However, we have to try and work with
cardiologists and so on, and it seems to me that we have to be able to communicate with them in terms they
understand. It is pointless us coming up with new ways of describing the same problem (although as I have said before
I do like Simon's risk analysis approach) and it is equally pointless us loading our CCUs with patients who can go
home. I dislike Adrian's term 'critical ischaemia' as that does not help at all - stable angina is critical ischaemia at and
above a certain cardiac output or flow rate within a given vessel. The difference with UNstable angina is that it can be
used as a catch-all for the patient who isn't having a barn-door MI but does need hospital care. I agree that from a
purists point of view it is as difficult to come to terms with as Adult Respiratory Distress Syndrome, but that is a useful
catch-all too.
Best wishes,
Rowley Cottingham
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