Highest Troponin Levels You've Seen?

[Dogstar]

Hello Everyone,

First, a caveat. I'm in my last semester of school doing a precepted clinical in CCU, so basically, I know absolutely nothing about anything. Please forgive my ignorance. If you would indulge me, I'd appreciate it.

Just curious -- what is the highest troponin level you've ever seen? I had a patient last week admitted through ER with an initial troponin of .21, chest pain, a slightly depressed ST segment (ECG normal otherwise), and a dx of r/o MI. During the night, his next two troponins came back at 78 and 144. He came to the unit on nitro and heparin drips and received an MS IV push twice for mild chest pain. We kept him NPO, the doc was, of course, notified (when each lab was received), and pt sent to the cath lab in am. He is now post-CABG and doing well. But 144?!! It seems pretty high to me, and my preceptor had never seen a number that high, either.

[aCRNAhopeful]

Ours don't read any higher than 80; it just says >80.

[resumecpr]

Try 250. Intubated, IAPB, tombstones. That was a fun night.

[Korinth]

Medical Overflow onto our oncology floor, troponin was 50. Apparently, he had been fainting at home for several days when they finally got him to come to the hospital.

[aCRNAhopeful]

Try 250. Intubated, IAPB, tombstones. That was a fun night.

Those massive MI cardiogenic shock patients are pretty nuts. Only had one or two of them in my short career but that does make for one crazy shift.

[NYNurseRN]

Actually, a coworker on the job, 300.

[teatree13]

Actual patient in nursing school 580.

[Floridanurse8257]

Just had one tonight 270.61 intubated, tombstones on the monitor, shock yep, was glad to send this man to the unit bed.

[tri-rn]

What are "tombstones" on the monitor?

[cardiacmadeline, RN]

tri-RN said:

What's "tombstones" on the monitor?

Elevated ST segments. They look like tombstones; you will know if you ever see them.

[pbear]

My institution stops counting at 100.

[Floridanurse8257]

To tri-RN: Tombstones are the elevations of the ST segment that are so high (in the lead II) that they resemble an upside-down U or an old-fashioned grave marker tombstone. It was long ago considered a very, very bad thing. It meant your patient had sustained damage to his/her heart and would likely need a tombstone soon. Now, though not a good thing to see, it is not necessarily an indication of impending death. New medicine, new treatments. Thank God.