I had my best call so far on the 12 March 2006, doing cardio posting on call.
Weekends were usually relatively quite (without much of the perioperative assessment referrals). And this was by far one of the most quite call I have ever had.
At 0435, my colleague in ED actually called me to review a case. A gentleman with history of end-stage renal failure on regular haemodialysis had presented with acute onset of dyspnoea but no chest pain. Coupled with the history of non-compliance to fluid restriction, and the antecedent history of inadequate dialysis, I was almost certain that it was a fluid overload case warranting urgent nephrology consultation.
I was called in for assistance as he was tested positive for CardioDetect(R) - a relatively new biomarker of myocardial injury with higher sensitivity but lower specificity compared to our good old Troponins. It was a falsely positive result as CardioDetect(R) - a human fatty-acid binding protein (h-FABP) can be elevated in renal failure and other muscular injuries as well. In other words, it is a good tool to rule out ACS, albeit an inadequate test to confirm one.
I printed out the article bearing the indications and limitations, together with the summary of the sensitivity and specificity of the test to my fellow colleagues in ED for their reference.
We learnt together by doing calls, seeing patients, albeit in a rather tiring way ;)
Weekends were usually relatively quite (without much of the perioperative assessment referrals). And this was by far one of the most quite call I have ever had.
At 0435, my colleague in ED actually called me to review a case. A gentleman with history of end-stage renal failure on regular haemodialysis had presented with acute onset of dyspnoea but no chest pain. Coupled with the history of non-compliance to fluid restriction, and the antecedent history of inadequate dialysis, I was almost certain that it was a fluid overload case warranting urgent nephrology consultation.
I was called in for assistance as he was tested positive for CardioDetect(R) - a relatively new biomarker of myocardial injury with higher sensitivity but lower specificity compared to our good old Troponins. It was a falsely positive result as CardioDetect(R) - a human fatty-acid binding protein (h-FABP) can be elevated in renal failure and other muscular injuries as well. In other words, it is a good tool to rule out ACS, albeit an inadequate test to confirm one.
I printed out the article bearing the indications and limitations, together with the summary of the sensitivity and specificity of the test to my fellow colleagues in ED for their reference.
We learnt together by doing calls, seeing patients, albeit in a rather tiring way ;)
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1 comment:
I had the same experience as you too. What I think, this CardioDetect(R) (whatever sensitive or specific it may be) is useless if it is done without specific indication. It appeared to me that our ED colleagues tried to do it when they could not think of any diagnosis to push the case to. For example, one of the patient that I encountered had complaint of dizziness and they did an ECG and noticed some non-specific T inversion in V1-V3. They did the "stupid" test and found it to be positive. So, do you trust the result? Another example was, a 80-year-old lady presented with stroke and was aphasic. ECG showed RBBB. The ED MO did that "stupid" test, I wondered why, and it was positive. So, did this patient have MI? I think it is useless if it is not indicated at all. My advice is, treat the patient and not the so called RapidCardio(R). I heard that this test is not approved for use yet, just some experimenting from the samples supplied by the sales rep. Until the ED MOs use the brain, I think Cardio MOs will have the tough time seeing unnecessary referrals.
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