Gautam, a topical area.
Claire Taylor presented our 'ROMEO' rapid rule out strategy for chest pain
at the Faculty meeting last week, one of three excellent presentations on
this topic I am told. ROMEO stands for Rule Out Myocardial Events on Obs
ward. We use troponin I on arrival and at 12 hours post pain onset to rule
out myocardial damage followed by an pre-discharge ETT in suitable patients
- we let the cardiac technicians do this. The TnI is a lab based test and is
turned round in an hour (actual assay time 14 mins). It costs between 3 and
ten pounds depending on what you include. We avoided the point of care kits
as we had doubts about quality control,they're expensive and may be
overused.
Another reason for going for lab testing was to ensure the lab were on board
and supported us. We put the proposal to management as a collaborative
venture between ourselves, cardiology and biochem. Having got the money, we
then sought the agreement of the general physicians before starting.
In my opinion, Andrew, this is core emergency work.If you can see a way to
improve emergency care for patients attending your department, you should
do it, regardless of territory or outdated definitions about core services.
We didn't need extra staff, though to do it well I think you need three
things - a single portal of entry, a 24 hour senior shop floor presence and
an Obs Unit (the holy trinity of emergency medicine?)
Steve Meek
RUH BATH
> ----------
> From: Gautam[SMTP:[log in to unmask]]
> Sent: 09 December 1999 21:41
> To: [log in to unmask]
> Subject: Troponins for MI
>
> ...or more accurately critical myocardial ischamia.
>
> We're about to start routine use of these to assist with diagnosis of
> chest pain sufferers.
>
> Numerous papers flying around (editorial in this week's BMJ), but would
> like to hear people's PRACTICAL experience of troponin use, assuming
> some of you already are using them.
>
> When to test?
> Still do CK-MBs?
> Allow home between serial tests?
> On strength of results: who to admit, who to discharge, who to refer
> urgently?
>
> Related subject: Boss came back from scientific A&E meeting last week,
> considering A&E staff doing exercice ECGs on dubious chest pains as an
> immediate investigation. I beleive this is common place in USA (chest
> pain assessment centres in Cincinnati etc.). Any thoughts?
>
> Dr G Ray
> Staff Grade
> A&E
> Sussex
> Reply to [log in to unmask]
>
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