cpeubob

I also reccomend Dubin - I used edition V. I know you ask for a book but if you get an opportunity attend the seminar "Cardiology for the Non-Cardiac Nurse" its presented by MED ED I think, they are out of Texas. I went to it in Feb. it was being presented in Pittsburg PA it lasted two days and the presentation on EKGs made it so easy to understand them I walked away feeling very confident in being able to interpret EKGs.

Patient arrives found unresponsive with narrow complex svt, given adenocard X3 via squad, upon arival to ER given adenocard again X2 then "juiced" with 100 joules and converted to st which went to sr, ct of head was negative, patient was on daily coumadin unable to get history to determine why, also hypertensive upon arrival and extremities slightly mottled - was known to have copd - and cool. Now for the question.............PTT was >120 and inr >10.8 right sided hemiparesis upon arrival to icu, BP 140s over 60s apical (is now sinus rhythm) high 80s to low 90s respers 22-30. remains unresponsive is on amiodarone qtt and d5 1/2ns.................cirrohis thats easy, what is going on??????

RULE #1 treat the patient not the monitor !!!!!!!!!!

ethel Go to the head of the class!!!!!

I spoke with lab today and it's all clear now. CK - 290, CKMB - 7.3 then to find the relative index CKMB divided by CK and multiply that answer by 100, that then becomes a percent. So 7.3(CKMB) divided by 290(CK) is 0.0251724, now multiply that by 100 which is 2.51724 or 2.5%, which is my facilitys cut off for cardiac vs. noncardiac. Why not just CK and Troponin ? This is just a guess but figuring the ratio is an additional tool to use to determine the cause of the elevation.

OK OK lets see if I have this right ..........CK - 290 CKMB - 7.3 so 100 = 3%, now that is 100 is the CK(290) and the 3% is the CKMB(7.3) hope I am right so far ? according to Angi O's info this is the upper limit for non-cardiac, have I managed to pull all this together or are the waters so muddy now we are all afraid to swim? As a side note they called me and ask me to come in today because the nurses working were "freaking" out about running a dobutrex drip, so of course I went in, and happen to speak with one of the cardioliogist and ask him about the formula for the CK - CKMB ratio, first he smiled then said he didn't know it off the top of his head - THE PLOT THICKENS LOL LOL LOL

Angie O I am aware of a fall etc causing the CK to elevate, but as I understand it (and this is what I am searching for) if the ratio is above/below a certain number it will indicate cardiac vs. non-cardiac. I am fully aware of the greater significance of Troponin as an indicator of MI, but as you replied your institution also does enzymes (CK, CKMB, and Troponin I assume) so there is obviously some significance in the CK and CKMB or we would only do Troponin. I think the importance lies in the CK - CKMB ratio, and therein lies my quest. . I work in a chest pain unit (in case you didn't guess that by my name ) and feel if I have this tidbit of knowledge maybe I can better benefit one patient.

I appreciate your response and I don't want to appear clueless but : CK = 290 CKMB = 7.30 ratio = ? is it as simple as 290 divided by 7.30 ? We don't get elevated Troponins on the floor they go to the unit, we also don't get EKG changes on the floor. I just want to have a clear understanding of this ratio information to be able to demonstrate more competence.

Had a patient discharged, D/C instructions given - IV out - telemetry off - waiting on family to transport, started saying "Oh my God I'm gonna die" "help me, help me" sent MONA in (Morphine,oxygen,nitro, OK not the ASA) was already on ASA. By the time (short time) she got to ICU she had "tombstone T waves" was a NSR on the floor prior to transfer. Patient saw Jesus ( I hope) two days later.

I have been searching/surfing for the formula to figure the CKMB ratio and can't find it. What should it be to indicate non-MI and when do we begin to suspect MI ? I have had patients with normal Troponin but elevated CK and CKMB but because the "ratio" was OK they were sent to the floor. Any help or links would be appreciated.

3-4 during the day? If I only have 3-4 they want to send me home due to low census, I usually start the day with between 7 and 9. It is so frustrating, when I started we had between 5-6 to start and now well anything goes, and they wonder why patient satisfaction surveys have gone in the toilet.