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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