January 2020 By PsychDB.com

Differences

This shows you the differences between two versions of the page.

Link to this comparison view

Both sides previous revision Previous revision
on-call:approach-to-im-on-call-emergencies-issues [May 2019]
PsychDB.com ↷ Links adapted because of a move operation
on-call:approach-to-im-on-call-emergencies-issues [January 2020] (current)
PsychDB.com
Line 43: Line 43:
   * **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