- Last edited on February 4, 2024
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| Both sides previous revision Previous revision | Previous revision | ||
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on-call:approach-to-im-on-call-emergencies-issues [on May 19, 2019] |
on-call:approach-to-im-on-call-emergencies-issues [on January 4, 2020] |
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| * **Troponin** | * **Troponin** | ||
| * **Troponins are NOT a substitute for clinical suspicion of an MI**. | * **Troponins are NOT a substitute for clinical suspicion of an MI**. | ||
| - | * Interpretation of troponin levels can be difficult. Troponins have high sensitivity (e.g. - good at ruling out an MI), but low specificity. A negative troponin and a stable troponin lets you rule out MI, but a positive one does not let you rule it in. Troponin elevations can either be “false positives” (chronic kidney disease, intracranial process, sympathetic stimulation), poor prognostic markers of non-ischemic disease (e.g. pulmonary embolism), or true indicators of ischemia (demand ischemia, NSTEMI, STEMI) | + | * Interpretation of troponin levels can be difficult. Troponins have high sensitivity (i.e. - good at ruling out an MI), but low specificity. A negative troponin and a stable troponin lets you rule out MI, but a positive one does not let you rule it in. Troponin elevations can either be “false positives” (chronic kidney disease, intracranial process, sympathetic stimulation), poor prognostic markers of non-ischemic disease (e.g. pulmonary embolism), or true indicators of ischemia (demand ischemia, NSTEMI, STEMI) |
| * Can order a serial CK and troponin in 4 hours to see if it trends upwards | * Can order a serial CK and troponin in 4 hours to see if it trends upwards | ||
| * A normal CK but elevated troponin is less likely to be an NSTEMI or STEMI | * A normal CK but elevated troponin is less likely to be an NSTEMI or STEMI | ||
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| ===== Insomnia ===== | ===== Insomnia ===== | ||
| - | <callout type="success">{{fa>arrow-circle-right?color=green}} See main article: **[[sleep:2-insomnia-disorder:home|]]**</callout> | + | <callout type="success">{{fa>arrow-circle-right?color=green}} See main article: **[[sleep:2-insomnia-disorder]]**</callout> |
| * If a patient is chronically on a benzodiazepine at home, do not stop them abruptly | * If a patient is chronically on a benzodiazepine at home, do not stop them abruptly | ||