High Sensitivity Troponins are RNG, prove me wrong.

[RustedFox]

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Title says it all.
Go back to normal troponins.
Thankyoupleasedrivethru.

 

[southerndoc]

Careful. Your post will cause your hsTrop to be high.

 

[Janders]

I would add the nuance that HS trop isnt fully random, but it takes a proper result like 0.1 and then adds to random numbers to it, and I’m not entirely sure these digits are significant.

0.1 —> 0.1 cool
0.128 —> 0.141 is this just the same thing or actual delta???

One of our sister hospitals was moving to Hs trop and asked a couple of us what we do with the mid-tier values that fall out of the “so low it’s not cardiac” zone but don’t enter “ oh this is ACS” zone. And they were disappointed to hear my answer which was it’s all vibes based! But it’s the honest truth. Pray they have an old trop that’s similar. Pray they have ckd you can blame it on. Get that delta and show it’s flat. 🤷‍♂️

 

[hoot504]

Our high-sensitivity troponin comes out in ng/L, and doesn't give us numbers after a decimal point. i.e. <6 is the lowest possible reading, and from there 7, 8, 9, 40, you get the idea.

We have an algorithm we generally adhere to with the expectation that we generally do at least one repeat unless HPI dictates otherwise. On the second troponin, a delta of <4 is considered insignificant, and you can stop there. Delta of 4 - 9 warrants a third troponin. 10 or greater and it's generally admit, call cardiology time.

Cardiac biomarkers of acute coronary syndrome: from history to high-sensitivity cardiac troponin - PubMed
This is the paper referenced to justify the algorithm.

 

[xaelia]

 

[Janders]

View attachment 412499

now if only I could communicate with such succinct wisdom 😭

 

[RustedFox]

View attachment 412499

I love the "midwit meme" format so much. Bravo.

 

[RustedFox]

Our high-sensitivity troponin comes out in ng/L, and doesn't give us numbers after a decimal point. i.e. <6 is the lowest possible reading, and from there 7, 8, 9, 40, you get the idea.

We have an algorithm we generally adhere to with the expectation that we generally do at least one repeat unless HPI dictates otherwise. On the second troponin, a delta of <4 is considered insignificant, and you can stop there. Delta of 4 - 9 warrants a third troponin. 10 or greater and it's generally admit, call cardiology time.

Cardiac biomarkers of acute coronary syndrome: from history to high-sensitivity cardiac troponin - PubMed
This is the paper referenced to justify the algorithm.

"Six-seven".

It becomes infinitely worse when 90+% of your patients are 900 years old and they all roll hsTnIs in the 30s and 40s all the damn time.
Meaningless numbers.

 

[hoot504]

"Six-seven".

It becomes infinitely worse when 90+% of your patients are 900 years old and they all roll hsTnIs in the 30s and 40s all the damn time.
Meaningless numbers.

I get the same numbers every shift. Most people have priors to compare to. It’s really not a big deal. If you’re stuck, well there’s always obs.

 

[thegenius]

Title says it all.
Go back to normal troponins.
Thankyoupleasedrivethru.

I think BP is more of a RNG (I had to look that up because you're a gamer) than hsTrop.

Do you know how many lives would be saved, each year, if the BP machines in the ED randomly gave a BP between 110 and 150? Every single time?

About 28,310.

How much money would be saved?

$37,490,838.

 

[thegenius]

"Six-seven".

STOP IT.

 

[RustedFox]

I get the same numbers every shift. Most people have priors to compare to. It’s really not a big deal. If you’re stuck, well there’s always obs.

Yeah but even that sucks, especially when you have to use Meditech to look at anything that's older than a few weeks.

You know what IS helpful? Seeing a result that says: "Trop < 0.05" and being done with it.

 

[Janders]

Yesterday guy with every cardiac risk factor, classic crescendoing excertional angina story, doesn’t come in for 8hr and now feels fine.

Trop 65
Delta in one hour is 50

It’s grossly positive. Normal renal function. Prior result of 12 last year different visit. The delta (while negative) is also grossly positive.

Treated, admitted.

Admission note is “troponin grossly flat 62–>50”

🤯

 

[RustedFox]

Make Numbers Meaningful Again.

 

[Janders]

Make Numbers Meaningful Again.

2+2=5

 

[RustedFox]

2+2=5

Too late for the "good" Radiohead list.

 

[Janders]

Back to idioteque then.