A look at national standards for emergency cardiac care for patients entering the accident and emergency system.
Written in 2004; 5,690 words; 53 sources; MLA; $ 137.95
Paper Summary:
This paper examines the standards set by the National Service Framework for coronary heart disease regarding emergency cardiac care for patients presenting to the accident and emergency system at a hospital. The paper explains that these standards place a priority on aggressive management and providing early thrombolysis and that this type of treatment is controversial because it is questionable whether, given the suggested timeline and the need to differentiate from non-cardiac causes of chest pain, an adequate history and physical can be performed to prevent the administration of thrombolytics in patients where they are contraindicated. To further examine this topic, the paper gives a clear definition of acute myocardial infarction, looks at how to diagnose a patient with acute chest pain, explores the history, indications, and contraindications of thrombolysis, and reviews a multidisciplinary approach to thrombolytic administration.
From the Paper:
"The definitive diagnosis of AMI is best obtained by following a standard chest pain protocol. Most accident and emergency wards have these in place. It is standard to initially obtain a 12 lead electrocardiogram (ECG) and begin cardiac monitoring. Patient's routine laboratory studies include electrolytes, blood urea nitrogen (BUN), complete blood count (CBC) and markers for myocardial injury (Creatinine Kinase isoenzyme-myocardial (CK-MB) or troponin). Normal serial CK values rule out an acute infarction but are negative in the setting of acute unstable angina. A slight rise in CK-MB or troponin indicates myocardial injury but is not specific for ischemic syndromes. Troponin assay is highly sensitive for identifying acute coronary syndromes. Troponin has longer half life in the system than CK-MB but is less specific for the identification of infarction as opposed to repeated episodes of myocardial ischemia. As the total CK greater than two times the upper ranges of normal is indicative of infarction it can be used as an adjunct in diagnosis ischemia versus infarction and also in determining the relative efficacy of reperfusion. Serum troponin may take up to six hours to become diagnostically sensitive enough (Dougan, 2001)."
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