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| Name | Learn to Love High Sensitivity Troponins | The EM & Acute Care Course |
| Video Uploader | Video From The Center for Medical Education |
| Upload Date | This Video Uploaded At 26-02-2021 19:00:08 |
| Video Discription | Learn to Love High Sensitivity Troponins by Jim Ducharme, MD Learn more, register for, or purchase the self-study version of the EM & Acute Care Course at https://courses.ccme.org/course/ema/about. KEY POINTS AND RECOMMENDATIONS 1. Even the most accurate troponin assay should not reassure you when the story and/or the ECG are high risk. Nothing has changed for those patients, even with an undetectable high-sensitivity troponin. Unstable angina is still a thing! 2. High sensitivity troponins are not negative or positive – they will be undetectable (below the limit of detection), measureable but below the 99th percentile (grey or “observe” zone), or measurable and above the 99th percentile (abnormal). The delta (or rate of rise) over 1-3 hours is important in interpreting detectable troponins. Rapidly rising (delta) troponins are indicative of myocardial injury even if below the 99th percentile threshold. 3. Higher troponin levels are associated with worsening prognosis, even if stable (not rising). 4. Consider non-ischemic cardiac and non-cardiac causes for presentation for all patients with detectable hs troponin. 5. Low-risk patients presenting after 3 hours with non-ischemic ECGs may be “ruled-out” with a single hs troponin result below the level of detection. These patients are at very low risk (less than 1%) of MACE (Major Adverse Cardiac Events). 6. Early presenters (less than 3 hours of symptoms) with undetectable troponin will require a delta troponin of between 1 and 3 hours before they can be confidently “ruled out.” 7. Patients with non-ischemic ECGs and detectable troponins below the 99th percentile at presentation will require a repeat sample. Patients with stable levels (unchanging) may not have acute myocardial ischemia, but they are at higher risk for both MACE and mortality than patients with undetectable troponins. These patients are in the “observe zone” – neither “rule-in” nor “rule-out.” There are no clear guidelines on the best management of these patients. 8. A combination of a clinical assessment and a second sample between 1 and 3 hours after the first is the recommended approach for serial sampling with hs troponin. ALL OF OUR COURSES: EM Boot Camp: http://www.embootcamp.com EM Boot Camp Pharmacology Workshop: https://bit.ly/2I44xld Advanced EM Boot Camp: http://www.embootcamp2.com EM & Acute Care: http://www.emacourse.com National EM Board Review: http://www.emboards.com High Risk Emergency Medicine: https://bit.ly/2VrvbYj The Heart Course: http://www.heartselfstudy.com The Cadaver-Based Suturing Self‑Study Course: https://bit.ly/36vn2Za EM:Prep LLSA Review: http://www.emprep.org National Family Medicine Board Review: http://www.fmboards.com The 2 View Podcast: Subscribe on Apple Podcasts: https://apple.co/3rhVNZw Subscribe on Google Podcasts: http://bit.ly/2MrAHcD Subscribe On Spotify: http://spoti.fi/3tDM4im pJReBrtWgXM |
| Category | Education |
| Tags | emergency medicine |
