Repeat trops and ekgs?

[applesxoranges, BSN, RN]

What is your physicians' normal ordering? My old jobs they would order trop/ekg and automatically order at least a 3 hour trip and ekg for chest pain but may discharge sooner. New facility/company orders I-stat trop stay and then repeat 2 hours and EKG only stat or change in condition.

I kind of thought the repeat trop/EKG at 3 hours was standard but apparently not since the three ERs I worked in before did it that way (2 same company, one independent). The other place I did agency at had them upstairs or out the door within 2 hours so it didn't really occur to me that it was different. No one hit the three hour mark there.

so how does your er normally do it? Obviously it will vary between physicians and individual patients.

[MunoRN, RN]

It mainly depends on when the symptoms started. Even the most sensitive troponin assays take about 4 hours after the beginning of a cardiac event to become elevated enough to be significant for diagnostic purposes. So if a patient presents to ED saying they've had chest pain for 2 days and it hasn't changed in the last few hours, then an initial troponin is actually sufficient. If the symptoms began just prior to arrival then you would need a troponin drawn about 4 hours from when the symptoms started to say with any confidence that they've been ruled out by troponins.

In general, studies show that about 80% of patients presenting to the ED for chest pain will be positive or at least have an obvious increase at the 2 hour troponin, so if the practice for all CP patients is to do a 2 hour troponin and then discharge if negative you'll catch about 80% of the people having an AMI, although that remaining 20% should still be worth using more patient specific timing for troponins and declaring a patient is ruled out.

[AZQuik]

We do stat, and 4 hour repeat usually

BSN GCU 2014. ED Residency

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[Lev, MSN, RN, NP]

Q3 hours if having chest pain, Q6 hours otherwise. EKGs with new/worsening chest pain or if symptomatic /rhythm changes. Stress test needs 2 troponins 6 hours apart.

[Uncle Rico]

Stat and mandatory 4hr repeat after the initial order at my facility, even if the Physician doesn't order.

[NurseOnAMotorcycle, ASN, RN]

Ours are generally labs and ekg q6 hours x3.

If inpatient, they usually order it q8 x2. If they want to discharge, they will do a single repeat as early as q4 hours, but I've never heard of q2 or q3 because as MunoRN stated, it takes at least 4 to 6 hours for any elevations to show. Unless they have an initial CIP elevation and are trying to see if it is rising or falling, q2 hour troponins seem like overkill.

[applesxoranges, BSN, RN]

Well, it isn't really q2. It has been a repeat in 2 if a physician orders but not usually.