Guest guest Posted February 6, 2002 Report Share Posted February 6, 2002 Larry Troponins rise within four to six hours after the beginning of chest pain or heart damage.Troponin I and T are considered superior cardiac markers for several reasons. The most significant is that cardiac troponins are the only markers specific for heart muscle, this we all ready know. remember first ECG may be -tive within the first 45 mins showing an elevation of the ST sement in two leads, constant monitoring and re examination within the first couple of hours any way. time points = admission, 2-4 hrs, 6-9 hrs, 12-24 hrs for troponins measure both an early and a definitive marker, if no increase of either marker by 24 hrs, rules out MI. early recognistion and administration of thrombolytics will improve mortality. When you look at the remote locations when it can take us 6 - 10 hours just to source an aircraft, then the flying time and patient transfer! every little bit helps. ECG Telemedicine, table top diagnosis and thrombolytics, this surely has got to be the way forward with remote medic locations. But a bit more research has got to be done with the remote locations for suitability as already mentioned. steve >From: Larry Torrey <ltorrey@...> >Reply- > >Subject: Re: Thrombolysing >Date: Wed, 06 Feb 2002 02:29:00 -0500 > >CKMB (the cardiac specific enzyme, and not CK, the more general enzyme) >will show up earlier than Troponin T. CKMB will show in about 2 hours >while it takes Troponin T about 6 hours. > >CKMB will show up earlier which is a good thing and is specific to >cardiac muscle, but it's less specific than Trop T. Trop T is more >sensitive, but shows up later. And on the other end of the time frames, >CKMB will return to normal in about 24-36 hours while Trop T stays >elevated for up to 2 weeks. > >So...a positive Trop T can mean an MI that is between 6 hours and 14 >days old. Add CKMB and, if positive, you can narrow it down to a 6-36 >hour window. A positive CKMB and a negative Trop can mean an MI that it >2-6 hours old. > >Obviously the EKG and clinical picture have to be considered in all of >this. > >Larry > >http://home.maine.rr.com/lat/serum-markers.jpg > > > >Owner@... wrote: > > > > I can check but I vaguely remember CK not being of much use in the > > initial > > management as it can take upto 24 hours to show where as the Trop T is > > a lot > > quicker indication?? > > > > Can't remember where I heard it but I'll check and come back to you, > > > > Ian > > > > Thrombolysing > > > > > > > > > > > > > > > > > > > > > > > > Any one on the list thrombolysing in the field? > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >_________________________________________________________________ > > > > > > > > > > > > Join the world's largest e-mail service with MSN > > > > Hotmail. > > > > > > > > > > > > http://www.hotmail.com > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > Member Information: > > > > > > > > > > > > > > > > > > > > > > > > List owner: Ian Sharpe Owner@... > > > > > > > > > > > > Editor: Ross Boardman > > Editor@... > > > > > > > > > > > > > > > > > > > > > > > > Post message: egroups > > > > > > > > > > > > Subscribe: > > > > -subscribeegroups > > > > > > > > > > > > Unsubscribe: > > > > -unsubscribeegroups > > > > > > > > > > > > > > > > > > > > > > > > Thank you for supporting Remote Medics Online. > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 6, 2002 Report Share Posted February 6, 2002 Yes, your right, but as I understand it, it takes longer to appear and test positive for, there is then a possibility that the thrombolising window could have passed. Ian H Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 6, 2002 Report Share Posted February 6, 2002 Thanks for that, I had it the other way around! Ian H Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 6, 2002 Report Share Posted February 6, 2002 This is more to my understanding, however, I have read that the ischaemic changes in the ECG can take a pair of hours. Ian H Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 6, 2002 Report Share Posted February 6, 2002 Agreed but this is longer term, the point of knowing Tropin T is to allow the clot buster to be given, if not by you/me, than get them to whoever can / vise versa. If chap is c/o chest pain that is not relieved with nitrates, O2 & rest, in a matter of hours, regardless of ECG changes or not; MI has to be ruled in or out. That may involve medivac depending on your facilities. I appreciate that the company will not take kindly to a false alarm but the health of the patient comes first. How many chest pains of this sort are you encountering, and what sort of health screening occurs prior to a 'really remote' job is undertaken? Ian H Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 6, 2002 Report Share Posted February 6, 2002 How quick can we check the CKMB in a remote location in comparison to Tropin? Ian H Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 6, 2002 Report Share Posted February 6, 2002 Steve, I think you restated a lot of what I already wrote. I'll agree that Troponin T has become the gold standard that CKMB once was, but my only point was that CKMB does have a role, even though it is less specific. The American College of Cardiology (www.acc.org) puts detectable Trop T release at 6 hours post-event, but naturally all of these numbers are ballpark. Let me ask - if you have a patient who presents to you with recurring episodes of chest pain (let's say daily over the past 7 days) and they have non-specific ST changes with a positive Trop T, do you lyse them? How do you know if the MI wasn't 7 days ago, and today you're seeing post-infarct angina? Where I work we might use CKMB to help nail down that time frame. Larry steve benbow wrote: > > Larry > > Troponins rise within four to six hours after the beginning of chest > pain or > heart damage.Troponin I and T are considered superior cardiac markers > for > several reasons. The most significant is that cardiac troponins are > the only > markers specific for heart muscle, this we all ready know. > > remember first ECG may be -tive within the first 45 mins showing an > elevation of the ST sement in two leads, constant monitoring and re > examination within the first couple of hours any way. > > time points = admission, 2-4 hrs, 6-9 hrs, 12-24 hrs for troponins > measure both an early and a definitive marker, if no increase of > either > marker by 24 hrs, rules out MI. > > early recognistion and administration of thrombolytics will improve > mortality. When you look at the remote locations when it can take us 6 > - 10 > hours just to source an aircraft, then the flying time and patient > transfer! > every little bit helps. > > ECG Telemedicine, table top diagnosis and thrombolytics, this surely > has > got to be the way forward with remote medic locations. But a bit more > research has got to be done with the remote locations for suitability > as > already mentioned. > > steve > > >From: Larry Torrey <ltorrey@...> > >Reply- > > > >Subject: Re: Thrombolysing > >Date: Wed, 06 Feb 2002 02:29:00 -0500 > > > >CKMB (the cardiac specific enzyme, and not CK, the more general > enzyme) > >will show up earlier than Troponin T. CKMB will show in about 2 > hours > >while it takes Troponin T about 6 hours. > > > >CKMB will show up earlier which is a good thing and is specific to > >cardiac muscle, but it's less specific than Trop T. Trop T is more > >sensitive, but shows up later. And on the other end of the time > frames, > >CKMB will return to normal in about 24-36 hours while Trop T stays > >elevated for up to 2 weeks. > > > >So...a positive Trop T can mean an MI that is between 6 hours and 14 > >days old. Add CKMB and, if positive, you can narrow it down to a > 6-36 > >hour window. A positive CKMB and a negative Trop can mean an MI that > it > >2-6 hours old. > > > >Obviously the EKG and clinical picture have to be considered in all > of > >this. > > > >Larry > > > >http://home.maine.rr.com/lat/serum-markers.jpg > > > > > > > >Owner@... wrote: > > > > > > I can check but I vaguely remember CK not being of much use in > the > > > initial > > > management as it can take upto 24 hours to show where as the Trop > T is > > > a lot > > > quicker indication?? > > > > > > Can't remember where I heard it but I'll check and come back to > you, > > > > > > Ian > > > > > > > Thrombolysing > > > > > > > > > > > > > > > > > > > > > > > > > > Any one on the list thrombolysing in the > field? > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >_________________________________________________________________ > > > > > > > > > > > > > Join the world's largest e-mail service with > MSN > > > > > Hotmail. > > > > > > > > > > > > > http://www.hotmail.com > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > Member Information: > > > > > > > > > > > > > > > > > > > > > > > > > > List owner: Ian Sharpe > Owner@... > > > > > > > > > > > > > Editor: Ross Boardman > > > Editor@... > > > > > > > > > > > > > > > > > > > > > > > > > > Post message: egroups > > > > > > > > > > > > > Subscribe: > > > > > -subscribeegroups > > > > > > > > > > > > > Unsubscribe: > > > > > -unsubscribeegroups > > > > > > > > > > > > > > > > > > > > > > > > > > Thank you for supporting Remote Medics Online. > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 6, 2002 Report Share Posted February 6, 2002 Larry Good point, but in a case like that I would seek more advise, plus being remote I hope that they would not have been kept in location that long. Taking full event of history, previous MI and such like,then passing it on would the top side doctor say go ahead and give the lyse... I dont know. Cheers Steve >From: Larry Torrey <ltorrey@...> >Reply- > >Subject: Re: Thrombolysing >Date: Wed, 06 Feb 2002 10:37:51 -0500 > >Steve, > >I think you restated a lot of what I already wrote. > >I'll agree that Troponin T has become the gold standard that CKMB once >was, but my only point was that CKMB does have a role, even though it is >less specific. The American College of Cardiology (www.acc.org) puts >detectable Trop T release at 6 hours post-event, but naturally all of >these numbers are ballpark. > >Let me ask - if you have a patient who presents to you with recurring >episodes of chest pain (let's say daily over the past 7 days) and they >have non-specific ST changes with a positive Trop T, do you lyse them? >How do you know if the MI wasn't 7 days ago, and today you're seeing >post-infarct angina? Where I work we might use CKMB to help nail down >that time frame. > >Larry > > >steve benbow wrote: > > > > Larry > > > > Troponins rise within four to six hours after the beginning of chest > > pain or > > heart damage.Troponin I and T are considered superior cardiac markers > > for > > several reasons. The most significant is that cardiac troponins are > > the only > > markers specific for heart muscle, this we all ready know. > > > > remember first ECG may be -tive within the first 45 mins showing an > > elevation of the ST sement in two leads, constant monitoring and re > > examination within the first couple of hours any way. > > > > time points = admission, 2-4 hrs, 6-9 hrs, 12-24 hrs for troponins > > measure both an early and a definitive marker, if no increase of > > either > > marker by 24 hrs, rules out MI. > > > > early recognistion and administration of thrombolytics will improve > > mortality. When you look at the remote locations when it can take us 6 > > - 10 > > hours just to source an aircraft, then the flying time and patient > > transfer! > > every little bit helps. > > > > ECG Telemedicine, table top diagnosis and thrombolytics, this surely > > has > > got to be the way forward with remote medic locations. But a bit more > > research has got to be done with the remote locations for suitability > > as > > already mentioned. > > > > steve > > > > >From: Larry Torrey <ltorrey@...> > > >Reply- > > > > > >Subject: Re: Thrombolysing > > >Date: Wed, 06 Feb 2002 02:29:00 -0500 > > > > > >CKMB (the cardiac specific enzyme, and not CK, the more general > > enzyme) > > >will show up earlier than Troponin T. CKMB will show in about 2 > > hours > > >while it takes Troponin T about 6 hours. > > > > > >CKMB will show up earlier which is a good thing and is specific to > > >cardiac muscle, but it's less specific than Trop T. Trop T is more > > >sensitive, but shows up later. And on the other end of the time > > frames, > > >CKMB will return to normal in about 24-36 hours while Trop T stays > > >elevated for up to 2 weeks. > > > > > >So...a positive Trop T can mean an MI that is between 6 hours and 14 > > >days old. Add CKMB and, if positive, you can narrow it down to a > > 6-36 > > >hour window. A positive CKMB and a negative Trop can mean an MI that > > it > > >2-6 hours old. > > > > > >Obviously the EKG and clinical picture have to be considered in all > > of > > >this. > > > > > >Larry > > > > > >http://home.maine.rr.com/lat/serum-markers.jpg > > > > > > > > > > > >Owner@... wrote: > > > > > > > > I can check but I vaguely remember CK not being of much use in > > the > > > > initial > > > > management as it can take upto 24 hours to show where as the Trop > > T is > > > > a lot > > > > quicker indication?? > > > > > > > > Can't remember where I heard it but I'll check and come back to > > you, > > > > > > > > Ian > > > > > > > > > > Thrombolysing > > > > > > > > > > > > > > > > > > > > > > > > > > > > Any one on the list thrombolysing in the > > field? > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >_________________________________________________________________ > > > > > > > > > > > > > > Join the world's largest e-mail service with > > MSN > > > > > > Hotmail. > > > > > > > > > > > > > > http://www.hotmail.com > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > Member Information: > > > > > > > > > > > > > > > > > > > > > > > > > > > > List owner: Ian Sharpe > > Owner@... > > > > > > > > > > > > > > Editor: Ross Boardman > > > > Editor@... > > > > > > > > > > > > > > > > > > > > > > > > > > > > Post message: egroups > > > > > > > > > > > > > > Subscribe: > > > > > > -subscribeegroups > > > > > > > > > > > > > > Unsubscribe: > > > > > > -unsubscribeegroups > > > > > > > > > > > > > > > > > > > > > > > > > > > > Thank you for supporting Remote Medics Online. > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 6, 2002 Report Share Posted February 6, 2002 If you're talking about CKMB, it takes a *shorter* time to appear than does Troponin. CKMB will show positive in about 2 hours, while Troponin T takes about 6 hours to show positive. The reason we all like Troponin so much is that it's only released by the heart, so there is little question as to what is going on. It's almost a no-brainer. If you can spare the extra time, Trop T is wonderful. CK will be elevated by skeletal muscle damage (from intense work or other mechanisms) and in some really severe cases CK seems to " drag " CKMB up and along with it, so you have to consider the circumstances behind those elevations. It's not the no-brainer that Trop T is, but it's a test with value nonetheless. Maybe you guys are being taught something different in your neck of the woods. I'm fairly accustomed to using these tests as I work in a trauma center and deal with these things every day. Best, Larry, RN, EMT-P ihub999cht@... wrote: > > Yes, your right, but as I understand it, it takes longer to appear and > test > positive for, there is then a possibility that the thrombolising > window could > have passed. > > Ian H Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 6, 2002 Report Share Posted February 6, 2002 Yes in fact there is a CK/MB & Troponin I test available that takes only 10 minutes with a study proven 99% accuracy level. Check www.cardiacstatus.com (I think that is the correct address). Be safe. Keep warm. Nick Nick Nudell, NREMT-P Glacier County EMS www.glacierems.com Northern Rockies Medical Center Cut Bank, MT Thrombolysing > > > > > > > > > > > > > > > > > > Any one on the list thrombolysing in the field? > > > > > > > > > > > > > > > > > > > > > >_________________________________________________________________ > > > > > > > > > Join the world's largest e-mail service with MSN > Hotmail. > > > > > > > > > http://www.hotmail.com > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > Member Information: > > > > > > > > > > > > > > > > > > List owner: Ian Sharpe Owner@... > > > > > > > > > Editor: Ross Boardman Editor@... > > > > > > > > > > > > > > > > > > Post message: egroups > > > > > > > > > Subscribe: > -subscribeegroups > > > > > > > > > Unsubscribe: > -unsubscribeegroups > > > > > > > > > > > > > > > > > > Thank you for supporting Remote Medics Online. > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 6, 2002 Report Share Posted February 6, 2002 ihub999cht@... wrote: > > Agreed but this is longer term, the point of knowing Tropin T is to > allow the clot buster to be given, if not by you/me, than get them to whoever > can / vise versa. If chap is c/o chest pain that is not relieved with > nitrates, O2 & rest, in a matter of hours, regardless of ECG changes or not; MI has > to be ruled in or out. That may involve medivac depending on your > facilities. I appreciate that the company will not take kindly to a false alarm but > the health of the patient comes first. This discussion seems to be going in circles, so maybe it's time for me to throw in the towel. You understandably want to concentrate on timeliness of the result, and I'm not sure that I know many other ways to say that CKMB gives you a quicker result than does Troponin. It can also help prevent you from lysing someone who presents with his complaint today, but had his heart atack 10 days ago (which is a bad thing), where Troppnin can't. I understand that I've been speaking in more esoteric terms if CKMB testing isn't available in your setting. Which one is quicker and better is one discussion, and which you have access to at your particular workplace is another. I was trying to discuss the former. > How many chest pains of this sort are you encountering, and what sort > of health screening occurs prior to a 'really remote' job is undertaken? I see a bunch of cardiac patients every day, but I mostly work in a hospital trauma room nowadays. My remote experience is mostly military, and we didn't and don't (I still teach and work with the military) do this kind of testing in the field. We just evac everyone. Ironically, we're getting farther and farther away from using serum markers in my emergency department. To save time, anyone with active chest pain and ST elevation in two leads goes straight to the cath lab, or gets lysed if the lab can't take them immediately. No CKMB, no Troponin. Larry RN, EMT-P Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 6, 2002 Report Share Posted February 6, 2002 Larry I agree, I have worked in a cardiac centre and I can assure everyone that ECG Changes in 2 consecutive or reciprocal leads chest pain and history \ age group will get TPA whist waiting for the Enzyme results and that is in a Major cardiac Unit. As You say, Enzymes can confirm MI but also timing, CKmb LDH etc. To cap it all I guess the conversation is about Remote locations with a medic working alone and the Only bedside test available if you are unsure is Tropinin... Now timing wise you should in a clear cut case be able to have some idea how Old the MI is with the ECG changes and how it has evolved. As for how many in a remote location you may get and what sort of pre health screening before assigned to remote locations that is one you would understand if you work in a private sector money making venture. Plus US law you cannot refuse employment to someone on the grounds of being too fat and smoking 100 a day and being 50..... So you are both right in different locations. CKmb is not practical in a remote location as you would need a Reflotron which is too expensive, With Tropinin T and ECG signs and symptoms I would say we should all be experienced enough to spot an MI compared to intercostal chondritidis... OK I don't want to hear anymore on B##*Y CK or MB or Tropinin everyone is right. Brash \ Gavin Lines Senior Nurse Supervisor Cabinda Gulf Oil Company e-mail: Amed2@... Telephone: CTN. 8 345 2696 Via London 020 74878100 Cabinda Ext. 2696 > Re: Thrombolysing > > ihub999cht@... wrote: > > > > Agreed but this is longer term, the point of knowing Tropin T is to > > allow the clot buster to be given, if not by you/me, than get them to > whoever > > can / vise versa. If chap is c/o chest pain that is not relieved with > > nitrates, O2 & rest, in a matter of hours, regardless of ECG changes or > not; MI has > > to be ruled in or out. That may involve medivac depending on your > > facilities. I appreciate that the company will not take kindly to a > false alarm but > > the health of the patient comes first. > > This discussion seems to be going in circles, so maybe it's time for me > to throw in the towel. You understandably want to concentrate on > timeliness of the result, and I'm not sure that I know many other ways > to say that CKMB gives you a quicker result than does Troponin. It can > also help prevent you from lysing someone who presents with his > complaint today, but had his heart atack 10 days ago (which is a bad > thing), where Troppnin can't. > > I understand that I've been speaking in more esoteric terms if CKMB > testing isn't available in your setting. Which one is quicker and > better is one discussion, and which you have access to at your > particular workplace is another. I was trying to discuss the former. > > > How many chest pains of this sort are you encountering, and what sort > > of health screening occurs prior to a 'really remote' job is undertaken? > > I see a bunch of cardiac patients every day, but I mostly work in a > hospital trauma room nowadays. My remote experience is mostly military, > and we didn't and don't (I still teach and work with the military) do > this kind of testing in the field. We just evac everyone. > > Ironically, we're getting farther and farther away from using serum > markers in my emergency department. To save time, anyone with active > chest pain and ST elevation in two leads goes straight to the cath lab, > or gets lysed if the lab can't take them immediately. No CKMB, no > Troponin. > > Larry RN, EMT-P > > > Member Information: > > List owner: Ian Sharpe Owner@... > Editor: Ross Boardman Editor@... > > Post message: egroups > Subscribe: -subscribeegroups > Unsubscribe: -unsubscribeegroups > > Thank you for supporting Remote Medics Online. > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 6, 2002 Report Share Posted February 6, 2002 Well said hehehe Don Sawyer 19 Heritage Drive Noosaville. Q. 4566 Australia ph 61 7 5473 0798 Re: Thrombolysing > > > > ihub999cht@... wrote: > > > > > > Agreed but this is longer term, the point of knowing Tropin T is to > > > allow the clot buster to be given, if not by you/me, than get them to > > whoever > > > can / vise versa. If chap is c/o chest pain that is not relieved with > > > nitrates, O2 & rest, in a matter of hours, regardless of ECG changes or > > not; MI has > > > to be ruled in or out. That may involve medivac depending on your > > > facilities. I appreciate that the company will not take kindly to a > > false alarm but > > > the health of the patient comes first. > > > > This discussion seems to be going in circles, so maybe it's time for me > > to throw in the towel. You understandably want to concentrate on > > timeliness of the result, and I'm not sure that I know many other ways > > to say that CKMB gives you a quicker result than does Troponin. It can > > also help prevent you from lysing someone who presents with his > > complaint today, but had his heart atack 10 days ago (which is a bad > > thing), where Troppnin can't. > > > > I understand that I've been speaking in more esoteric terms if CKMB > > testing isn't available in your setting. Which one is quicker and > > better is one discussion, and which you have access to at your > > particular workplace is another. I was trying to discuss the former. > > > > > How many chest pains of this sort are you encountering, and what sort > > > of health screening occurs prior to a 'really remote' job is undertaken? > > > > I see a bunch of cardiac patients every day, but I mostly work in a > > hospital trauma room nowadays. My remote experience is mostly military, > > and we didn't and don't (I still teach and work with the military) do > > this kind of testing in the field. We just evac everyone. > > > > Ironically, we're getting farther and farther away from using serum > > markers in my emergency department. To save time, anyone with active > > chest pain and ST elevation in two leads goes straight to the cath lab, > > or gets lysed if the lab can't take them immediately. No CKMB, no > > Troponin. > > > > Larry RN, EMT-P > > > > > > Member Information: > > > > List owner: Ian Sharpe Owner@... > > Editor: Ross Boardman Editor@... > > > > Post message: egroups > > Subscribe: -subscribeegroups > > Unsubscribe: -unsubscribeegroups > > > > Thank you for supporting Remote Medics Online. > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 7, 2002 Report Share Posted February 7, 2002 Hi Ian, Re medevac and false alarms the companies now are becoming more health conscious. (as are the rest of the public) I ve medivaced 2 x Non specific chest pains in recent months and the company just seemed to accept it, granted most of the reputable ones usually have insurance to cover medevacs so no one is really bothered. The decision to send them out was taken by the topside doc after taking in my opinion and Hx etc. Iteresting to note though that neither had notable ECG changes. Both returned to work the following trip and we are still non the wiser as to the cause....... I think the trop t test would be a useful addition to our armoury though, it takes between 4-6 hours to arrange a specific medevac aircraft and I think the value outweighs the cost Best Wishes Ian Re: Thrombolysing Agreed but this is longer term, the point of knowing Tropin T is to allow the clot buster to be given, if not by you/me, than get them to whoever can / vise versa. If chap is c/o chest pain that is not relieved with nitrates, O2 & rest, in a matter of hours, regardless of ECG changes or not; MI has to be ruled in or out. That may involve medivac depending on your facilities. I appreciate that the company will not take kindly to a false alarm but the health of the patient comes first. How many chest pains of this sort are you encountering, and what sort of health screening occurs prior to a 'really remote' job is undertaken? Ian H Quote Link to comment Share on other sites More sharing options...
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