Tamingthesru
Grand Rounds Recap 9/2
Evidence-Based Medicine: Meningitis with Drs. O'Brien and Teuber
- In one study, 95% of people with meningitis had 2 of fever, headache, meningismus but only 44% had all 3
- CT prior to LP? The American College of Radiology says do it for papilledema, altered mental status, focal neuro deficit, immunocompromised stated, history of CNS disease.
Grand Rounds Recap 8/26
M&M with Dr. LaFollette
Case 1: Troponin Use in ESRD
- Evaluating cardiac ischemia in ESRD patients can be difficult due to baseline troponin elevations. However, all is not lost...
- Troponins can be used as a reliable marker of ischemia, even despite its collection in proximity to dialysis, if you take some things into account:
- Studies vary widely on troponin levels during dialysis, consensus being that troponin levels do not vary significantly vary with dialysis.
- Although the baseline may be abnormally elevated, ESRD patients nonetheless have a new baseline. Changes above this baseline and especially up trending troponins should trigger alarms that the patient may be having active ischemia.
- Troponin elevation in ESRD patients, even if at their baseline, is an independent risk factor for short term mortality
STEMI and STEMI Equivalents, i.e. Who Needs the Cath Lab Now!
1. The ACC/AHA Criteria (1) (2)
ST-elevation in 2 contiguous leads that is:
Men < 40: 2.5 mm ST-elevation in V2 or V3, 1 mm in any other lead
Men > 40: 2.0 mm ST-elevation in V2 or V3, 1 mm in any other lead
Women: >1.5 mm ST-elevation in V2 or V3, 1 mm in any other lead
STEMI's have a 90-minute door-to-balloon time mandate from the Center for Medicare Services (CMS). To be good stewards of our resources we need to be familiar the false positive STEMI patterns. Ultimately, however, some degree of over triage and activation for false positives is expected and (potentially even) desirable.