In message <[log in to unmask]>, [log in to unmask] writes
>Carlos,
>Why do you need to use Troponin in category three patients?
>Wouldnt a standard cardiac enzymes assay do just as well at six hours plus?
>
>Regards,
>Rocky.
My limited understanding of troponins is that they are more sensitive
(at 4-6 hours) than CK-MB at picking up the "critical ischaemics",
before there is sufficient lysis to show up on a CK-MB test. We are
looking at a protocol that involves troponins at 4 hours in the category
3 patients (described by Mr. Perez-Avilla), during which time the
patient sits on a monitor in A&E. If these levels (and a repeat ECG) are
OK, the plan is to discharge them (with appropriate advice), to return
at onset+12 hours for a further troponin level. I am told that the
available evidence supports this as a practical "risk management"
strategy to reduce the risk of discharging MIs. There have been recent
papers on the subject in Annals of Emergency Med. The idea of immediate
"stress-testing" in A&E appeals, if only to avoid the unecessary 4 hour
waits for the huge majority (paper in last months Annals of EM), but
can't quite see it working in practice in most resource-strapped DGH's,
likwise dynamic vector-cardiography or Cincinnatti-style "chest pain
ERs".
===========================================================================
Goat
(e-mail: [log in to unmask])
Sussex, U.K.
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