Pre Hospital Troponin Testing

[Flight-LP]

Very good point. However, we rarely ever had a transport last longer than 2 hours, much less 5......................He!!, for a while I was in a Bell 206, couldn't carry that much fuel if we wanted to!

We also kept the cartridges in the cooler / fridge (depended on the aircraft). Ironically, right next to the Ativan................

On to that thread now...............

 

[VentMedic]

Very good point. However, we rarely ever had a transport last longer than 2 hours, much less 5......................He!!, for a while I was in a Bell 206, couldn't carry that much fuel if we wanted to!

Neo and Pedi transports...we do the islands, South America and Mexico occasionally as well as a couple of different states.

 

[RJ80]

Okay, okay, I know, I'm resurrecting an old thread, but I stumbled on this one while google searching some research for some troponin markers.

I see that many of you have looked at using the IStat and like it but with limitations. Have you considered qualitative tests instead? That was what I was researching when I found this thread. I'm trying to tlk my boss into spending money on these things.

www.tntdiagnostics.com/TNTProducts-Cardiac Marker Tests.php

I got a couple of samples from the company and they seem to be pretty easy to use and to store.

What do you folks think?

 

[Hellsbells]

I have to admit that personally I have little experience with triponin testing. However, It seems that if there is a reliable method for testing in the prehospital environment it would be of some value. Im thinking in particular of those rural services that have protocols for on car thrombolytics. In those cases id say it would be a very valuable adjunct for therapy, again presuming there is a cost effective, quick and reliable method in place for testing.

 

[systemet]

Im thinking in particular of those rural services that have protocols for on car thrombolytics. In those cases id say it would be a very valuable adjunct for therapy, again presuming there is a cost effective, quick and reliable method in place for testing.

The problem with that is that you thrombolyse based on the presence of STEMI, the absence of absolute contraindications, and the balance of relative contraindications and PCI availability.

If you have a NSTEMI with positive troponin, it's usually adjunctive therapy (plavix, enoxaparin), and PCI. While I'm sure there's probably some inhospital exception that I'm not aware of, you don't thrombolyse NSTEMIs.

 

[ArcticKat]

It would be a nice confirmation to backup the STEMI and if it's a NSTEMI with elevated trops we could administrate plavix and enoxaparin.

Does anyone have those meds in their scope of practice? We don't, but with prehospital trops it may be something we can include.

RJ80, any idea of the cost?

 

[RJ80]

The kits I got cost $13 for just a troponin test, and $18 for a combined trop/myo test. They have a shelf life of about 18 months and can be stored at room temp.

 

[systemet]

It would be a nice confirmation to backup the STEMI and if it's a NSTEMI with elevated trops we could administrate plavix and enoxaparin.

Agreed. With the obvious caveat that some early STEMIs will be troponin negative, but still receive huge benefit from thrombolytics.

]Does anyone have those meds in their scope of practice? We don't, but with prehospital trops it may be something we can include.

We used them in my old job. When we had a STEMI, we faxed to a cardiologist, and then depending on resources and patient condition went direct to PCI (+ plavix + enoxaparin), or gave TNK.

The trick with this sort of thing, as I see it, is not to have the specific drugs the paramedics can administer written in a legal statute, because it takes too long to change. If the relevant sections of whatever laws govern EMS say "the paramedic may administer IV medication", it makes it a lot easier for medical control to introduce new therapies.

 

[ArcticKat]

Unfortunately our College has a very strict zero tolerance policy regarding scope of practice and protocols which are very specific and detailed. It wasn't quite so bad in the past when our government regulated us and considered the protocols as guidelines to care and the occasional stray was considered good patient care when it was rationalized properly.

Now that we have our own licences and professional regulatory body we aren't given quite so much latitude. I believe it's because our College is afraid of losing its training wheels and being relegated back to obscurity.

 

[TxParamedic]

we are trial testing the Nanogen cardiac STATus for CK-MB, Troponin. For the most part to give the ER Doc more info to make a decision to transport to a higher level of care without waiting for labs to come back. Keeping in mind it takes us about 30 minutes to get a helo and the nearest cath lab is over an hour away by ground.

 

[rexbanner]

Old Post! Sorry! But new info!

www . edmontonjournal.com/health/Tiny+labs+inside+Edmonton+ambulances+could+save+cardiac+patients+lives/5465578/story.html

please add the www . together since the forum wouldnt allow it since Im new. However it is clearly not spam.

Been giving TNK for about 7 or 8 years (inc trial). Now starting with this. In the future if it goes past trial it probably won't do anything prehospitally except change our destination to a hospital with PCI. Currently, as it states in the article and is often the case, NSTEMI can wait up to 3-4 days to get a cath. (We have about 10 hospitals regionally vairying in care type, but only 2 with PCI).

Dr. Welsh is very proactive and this trial "Proact" is just another example of that.