Cardiac enzymes

[Direct Laryngoscopy]

Quick question.

When You have a pt come in as code 66 (CVA) is it standard to get cardiac enzymes on all these pts. or do you only do it for pts. with co-morbidities (HTN, CAD, DM, etc.), or do you just get a set to appease the service the pt will be admitted to (Neurology, Medicine, ICU)? Whats you reasoning for doing or not doing the tests? (Just interested)


Thanks in advance yo

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[margaritaboy]

There is a significant number of people with CVAs that have coexisting acute cardiac ischemia. I don't really know why this is true, but it is. Elderly patients will frequently present with a change in mental status as an initial sign of AMI.

Consider your CVA and elderly patients at high risk for cardiac ischemia, and get some enzymes.

 

[SoCuteMD]

do you just get a set to appease the service the pt will be admitted to (Neurology, Medicine, ICU)?

In the ED I spend time in we don't order anything purely to appease the service the patient will be admitted to. If it's indicated and they would like it, we'll order it.

Ha, I say "we" as if my name appears next to any order.

With that said, I don't know the answer to your question.

 

[Direct Laryngoscopy]

In the ED I spend time in we don't order anything purely to appease the service the patient will be admitted to. If it's indicated and they would like it, we'll order it.

The reason I ask is because I have seen attendings (and residents) from other services practically demand that the ED attending (or resident) order a certain lab or test, before admission to a service. More often then not (from my own experience), the ED doc does the test. Nothing outrageous like nuclear med or MRI but on a smaller scale

 

[SoCuteMD]

The reason I ask is because I have seen attendings (and residents) from other services practically demand that the ED attending (or resident) order a certain lab or test, before admission to a service. More often then not (from my own experience), the ED doc does the test. Nothing outrageous like nuclear med or MRI but on a smaller scale

Yeah, I know it's that way at a lot of places. The place I work is, uh, "resource-limited" so we only do what is absolutely necessary. Let Internal Medicine run up their budget if they want to order unnecessary tests .

 

[NinerNiner999]

Keep in mind also that the CK-MB contains a fraction of BRAIN markers in it as well, and can be elevated during cerebral infarction just like in myocardial infarction...