At the unit where I work our CP protocol uses cpk and tro I upon arrival to er or unit then 6hrs later another cpk, and then in another 6hrs we get a final cpk and trop I, and then they will have aa EST and if they pass the get discharged.. My question is in general how often have you been finding the 1st trop to be WNL and the final trop to be elevated? and also someone share with me if they are using any other cardiac markers that they feel is working well
Jan 2, '01
I work cardiac step-down, we have a chest-pain protocol -24 hour max stay. Pretty much just use trop I. Probably 30% of the ones that rule in for an MI were initially negative or indeterminate (<2.0). Depends on how quickly they make there way to ER. We also require a fasting lipid, serial EKGs and 90% get a stress test once MI is ruled out.
Jan 5, '01
Some of the facilities use markers q 6 and others q8.
If the hospital has beds that day we keep the patient overnight.
If the beds are tight they rule out in the ER and go home from there.
If EKG is Neg and Troponin is neg x 2 its home you go.
If you have chest pain relieved with SL Nitro and the EKG and Labs are neg you go home and follow up with stress test unless you die first.
The true indicator used for deciding to keep the patient is the bed situation sad but true