Thrombolysis in Critical Care

Paper Summary:

This paper studies how medical professionals diagnose and treat thrombolysis during critical care for patients experiencing chest pain. The paper provides a detailed analysis of scientific and clinical evidence indicating that patients experiencing acute myocardial infarction benefit from the early administration of thrombolytic therapy. The paper then discusses the challenge for multidisciplinary providers in ensuring that patients give true informed consent for all procedures, from administration of medication to invasive procedures. The paper explains that the setting can be chaotic, however, it maintains that effective communication between patients and providers is imperative.

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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