Related Experiment Video
Updated: Jul 28, 2026
09:52
Setting Up a Stroke Team Algorithm and Conducting Simulation-based Training in the Emergency Department - A Practical Guide
Published on: January 15, 2017
Effective resource management using a clinical and laboratory algorithm for chest pain triage.
L Bernstein1, A M Spiekerman, A Qamar
1Bridgeport Hospital, CT, USA.
Clinical Laboratory Management Review : Official Publication of the Clinical Laboratory Management Association
|February 7, 1996
Summary
Cardiac troponin-T improves emergency department triage for chest pain patients. This biomarker aids in accurately identifying acute myocardial infarction (AMI) and unstable angina, reducing unnecessary admissions and facilitating timely treatment.
Area of Science:
- Cardiology
- Emergency Medicine
- Clinical Diagnostics
Background:
- A study compared a clinical algorithm with unaided physicians for triaging 200 emergency department (ED) patients with chest pain.
- The goal was to improve the accuracy of Coronary Care Unit (CCU) admission decisions.
Purpose of the Study:
- To evaluate cardiac troponin-T as an adjunct to a clinical algorithm for acute myocardial infarction (AMI) detection.
- To assess the potential for faster patient treatment and reduced hospital costs.
Main Methods:
- Compared clinical and electrocardiogram criteria (Goldman algorithm) with troponin-T and creatine kinase-MB isoenzyme (CK-MB) testing.
- Measured CK-MB at triage and 4, 8, 12 hours; measured LD1 and total lactate dehydrogenase at 12 hours.
- Measured cardiac troponin-T on ED arrival and 4 hours later.
Main Results:
- CK-MB testing identified 37 non-AMIs but missed 8 AMIs and 10 unstable angina cases.
- Troponin-T identified 6 additional cases of unstable angina missed by CK-MB.
- A total of 14 cases (5.6%) of AMI or unstable angina were initially unaccounted for by CK-MB.
Conclusions:
- Cardiac troponin-T is a valuable adjunct for accurately selecting chest pain patients for CCU admission.
- Utilizing troponin-T can lead to more rapid treatment of non-AMI patients and potential cost savings.
- The findings support the integration of troponin-T into clinical algorithms for improved chest pain management.
More Related Videos
11:27A Modified Sonographic Algorithm for Image Acquisition in Life-Threatening Emergencies in the Critically Ill Newborn
Published on: April 7, 2023
06:16Signal Acquisition, Score Interpretation, and Economics of a Non-Invasive Point-of-Care Test for Coronary Artery Disease
Published on: August 9, 2024
Related Concept Videos
01:26Flail Chest-II
Managing flail chest, a condition characterized by a segment of the chest wall moving independently from the rest of the thoracic cage, requires a comprehensive approach. It includes a thorough assessment of the patient's condition, a diagnostic evaluation to determine the extent of the injury, and the implementation of appropriate medical interventions tailored to the individual's needs.
Assessment:
1. Clinical Evaluation:
History:
Assessment:
1. Clinical Evaluation:
History:
01:30Acute Coronary Syndrome III: Diagnostic Studies
Diagnosing acute coronary syndrome or ACS begins with a thorough patient history. Notable symptoms include central, crushing chest pain radiating to the left arm, neck, jaw, or back, along with shortness of breath, sweating (diaphoresis), nausea, vomiting, dizziness, and palpitations.It is crucial to note any history of cardiac illnesses and assess risk factors, including age, gender, smoking, hypertension, diabetes, hyperlipidemia, and a sedentary lifestyle.During physical examination, vital...
01:28Acute Coronary Syndrome IV: Interprofessional Care
IntroductionThe management of Acute Coronary Syndrome (ACS) aims to minimize myocardial damage, preserve myocardial function, and prevent complications.Initial ManagementInpatient management involves continuous cardiac monitoring, preferably in an ICU, focusing on blood pressure, serum sodium, potassium, and creatinine levels, and urine output. Ongoing pharmacologic management is crucial for stabilizing the patient.Supplemental Oxygen: Administer supplemental oxygen if oxygen saturation is...
01:26Acute Coronary Syndrome V: Nursing Management
Nursing Assessment:Nursing management of acute coronary syndrome (ACS) involves taking the patient's history, focusing on primary complaints such as chest pain, dyspnea, and excessive sweating (diaphoresis), as well as other symptoms like back or jaw pain, nausea, vomiting, palpitations, dizziness, and fatigue. The nurse also reviews the patient's history of cardiac events, risk factors such as hypertension, diabetes, smoking, family history, and current medications.In the objective assessment,...
01:29Angina III: Clinical Manifestations and Assessment
Angina manifests as chest pain, tightness, or squeezing discomfort typically located behind the breastbone. It can radiate to the neck, jaw, shoulders, and inner aspects of the upper arms, most commonly the left arm. Patients may experience shortness of breath, fatigue, profuse sweating, dizziness, indigestion, heartburn, palpitations, anxiety, and vomiting as accompanying symptoms. This pain often lasts a few minutes and is triggered by physical exertion, emotional stress, heavy meals, or cold...
01:20Angina V: Nursing Management
Angina, a symptom of myocardial ischemia, requires a structured nursing management approach to ensure effective care and prevent complications like myocardial infarction. Comprehensive nursing care involves assessing, diagnosing, planning, implementing interventions, and evaluating outcomes, all tailored to the individual patient's needs.Patient AssessmentNursing assessment begins with a detailed subjective evaluation of symptoms, which typically include chest pain or pressure radiating to the...