Comments on: Use of myoglobin for cardiac injury http://www.kevinmd.com/blog/2004/09/use-of-myoglobin-for-cardiac-injury.html medical blog Mon, 23 Nov 2009 01:35:28 -0500 http://wordpress.org/?v=2.8.4 hourly 1 By: Anonymous http://www.kevinmd.com/blog/2004/09/use-of-myoglobin-for-cardiac-injury.html/comment-page-1#comment-66887 Anonymous Fri, 08 Sep 2006 11:06:00 +0000 http://clients.emmense.com/kevinmd/2004/09/use-of-myoglobin-for-cardiac-injury.html#comment-66887 I WORK IN A SMALL HOSPITAL CLOSE TO LEXINGTON, KY. THEY ARE DOING THE 24 HOUR OBSERVATION FOR PATIENTS PRESENTING WITH CHEST PAIN AND THE FIRST SET OF ENZYMES ARE NEGATIVE. I HAVE SEEN FIRST HAND OVER THE PAST 6 MONTHS , AT LEAST ONCE OR TWICE A WEEK, ONE OF THE OBSERVATION PATIENTS BEING POSITIVE BEFORE THE SECOND SET OF ENZYMES. SEVERAL OF THESE PATIENTS HAVE BEEN IN THEIR 30'S AND 40'S. ONE YOUNG WOMAN WAS COMPLAINING OF SHOULDER PAIN. HER TROPONIN WAS EXTREMLY HIGH THE SECOND SET OF ENZYMES. WE HAD ALREADY STARTED RETAVASE BASED ON EKG CHANGES. SHE WAS TAKEN STRAIGHT TO THE CATH LAB AND HAD STENTS PLACED. SHE SAID WE SAVED HER LIFE. I WORK IN A SMALL HOSPITAL CLOSE TO LEXINGTON, KY. THEY ARE DOING THE 24 HOUR OBSERVATION FOR PATIENTS PRESENTING WITH CHEST PAIN AND THE FIRST SET OF ENZYMES ARE NEGATIVE. I HAVE SEEN FIRST HAND OVER THE PAST 6 MONTHS , AT LEAST ONCE OR TWICE A WEEK, ONE OF THE OBSERVATION PATIENTS BEING POSITIVE BEFORE THE SECOND SET OF ENZYMES. SEVERAL OF THESE PATIENTS HAVE BEEN IN THEIR 30′S AND 40′S. ONE YOUNG WOMAN WAS COMPLAINING OF SHOULDER PAIN. HER TROPONIN WAS EXTREMLY HIGH THE SECOND SET OF ENZYMES. WE HAD ALREADY STARTED RETAVASE BASED ON EKG CHANGES. SHE WAS TAKEN STRAIGHT TO THE CATH LAB AND HAD STENTS PLACED. SHE SAID WE SAVED HER LIFE.

]]> By: Nick http://www.kevinmd.com/blog/2004/09/use-of-myoglobin-for-cardiac-injury.html/comment-page-1#comment-51676 Nick Mon, 27 Sep 2004 18:06:00 +0000 http://clients.emmense.com/kevinmd/2004/09/use-of-myoglobin-for-cardiac-injury.html#comment-51676 I just finished two months in Emergency and this topic was of some interest for me. Right now the conservative ED attendings (ie, most of them) admit almost everyone with a reasonable story of chest pain -- even if they're young, healthy, and the first set of enzymes and EKG is normal. 12-24 hours of observation plus a stress test is a hassle for everyone (including the patient), but the risk of sending someone home with an MI is too great to ignore. And, as recent US and UK studies show, that still happens 2-4% of the time.<br /><br />But one estimate of the cost-per-life-saved of admitting low-probability patients is US$1 million. <br /><br />What to do? The problem with myoglobin, as you and UTD state, is it's nonspecific. In fact, many of the same young, low-risk patients coming in with chest pain are manual laborers who could easily have high myoglobin from skeletal muscle damage.<br /><br />More hospitals are setting up Chest Pain centers, where "rule outs" can be sent for observation without clogging up the rest of the emergency department. It should I haven't seen one of these places yet but I hear should cost less, be easier on the patient, and make everyone more comfortable about doing the appropriate workup. I just finished two months in Emergency and this topic was of some interest for me. Right now the conservative ED attendings (ie, most of them) admit almost everyone with a reasonable story of chest pain — even if they’re young, healthy, and the first set of enzymes and EKG is normal. 12-24 hours of observation plus a stress test is a hassle for everyone (including the patient), but the risk of sending someone home with an MI is too great to ignore. And, as recent US and UK studies show, that still happens 2-4% of the time.

But one estimate of the cost-per-life-saved of admitting low-probability patients is US$1 million.

What to do? The problem with myoglobin, as you and UTD state, is it’s nonspecific. In fact, many of the same young, low-risk patients coming in with chest pain are manual laborers who could easily have high myoglobin from skeletal muscle damage.

More hospitals are setting up Chest Pain centers, where “rule outs” can be sent for observation without clogging up the rest of the emergency department. It should I haven’t seen one of these places yet but I hear should cost less, be easier on the patient, and make everyone more comfortable about doing the appropriate workup.

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