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AQT90 FLEX parameters 24/05/2017 In the waiting room Emergency AQT90 FLEX parameters Cardiac markers Infection marker Myoglobin CRP CKMB Troponin I Hemostasis marker NT-proBNP D-dimer Pregnancy marker ßhCG The patient in the hospital Treatment and monitoring of heart conditions Cardiac markers Diagnosis based on: Patient with heart conditions •Clinical assessment Treatment and monitoring of sepsis •Biochemical tests Patient •Other tests Patient with sepsis Infection markers Treatment and monitoring of coagulation disturbances Patient with other problems Patient with coagulation disturbances Hemostasis markers AQT is only a piece in the puzzle The blood supply to the heart muscle The heart muscle does not receive any nutrients or oxygen from the blood in the heart chambers The heart receives oxygen and nutrients from the blood in the coronary arteries Acute myocardial infarction (AMI) Obstruction of the coronary artery Lack of oxygen to the cardiac muscle Muscle-cell degradation and loss of function Cardiac marker release Clinical application of troponin I Troponin I is a late but very sensitive and specific indicator of damage to the heart muscle Troponin I is used to determine whether the patient has suffered from an AMI Clinical application of myoglobin Myoglobin testing is used to help rule out a heart attack High levels of myoglobin usually require the use of other tests such as CKMB or troponin I to tell whether the damage is to heart or to other skeletal muscles Clinical application of CKMB CKMB level is tested to: Diagnose a heart attack Detect reinfarction Congestive heart failure (CHF) If the right side of the heart fails, fluid will accumulate in the body, causing swelling of the ankles and legs, along with discomfort in the abdomen If the left side of the heart fails, the blood will accumulate in the lungs, resulting in pulmonary edema Normal heart Heart failure Clinical application of BNP/NT-proBNP BNP/NT-proBNP may be ordered to: Diagnose heart failure Grade the severity of the heart failure An accurate diagnosis is important because heart failure can be successfully managed with various medical treatments. The hemostatic system The hemostatic system maintains the balance between bleeding and building a thrombus in the body If there are disturbances in the haemostatic system the patient will have either a bleeding disorder or excessive clotting which can lead to thrombus formation Bleeding Thrombus formation What is deep vein thrombosis (DVT) DVT involves clot formation in the deep veins of the body, most frequently in the legs These clots may grow very large and block the blood flow in the legs Pulmonary embolism (PE) An embolism occurs when propagating blood clots break loose and follow the bloodstream until the blood vessels are so small that the embolism will get stuck and block the blood passage Clinical application of D-dimer? D-dimer has a high negative predictive value, i.e. it can be used to rule out diseases caused by excessive clotting: Deep vein thrombosis, DVT Pulmonary embolism, PE Infection Infection is a disease caused by microorganisms like bacteria's, viruses or fungi There are many different kinds of infection, e.g: Sepsis Pneumonia Wound infection Influenza Cold Sepsis Sepsis is a deadly form of blood poisoning 1,400 people die worldwide due to sepsis – every day! The microorganisms can enter the blood via an infection in the body or because of a defect skin or mucosa barrier Sepsis may lead to multiple organ failure and death Mortality rate of ~ 30 % Sepsis can strike anyone but is most likely to develop from infections associated with pneumonia, trauma and surgery Clinical applications of CRP CRP is ordered: When acute inflammation is suspected To help evaluate chronic inflammation conditions To determine whether treatment of an inflammatory disease is effective since CRP levels drop as the inflammation subsides As a very rough indication for heart disease risk Why have a pregnancy marker? Accurate determination of whether a patient is pregnant or not prior to starting treatment is essential for emergency medicine providers in order to be able to provide the correct care in all situations Especially when you want an X-ray taken or to start a treatment with a medication known to be dangerous for the fetus What is an ectopic pregnancy? An ectopic pregnancy is a condition where a fertilized egg settles and grows in any location other than the inner lining of the uterus Clinical applications of βhCG assays βhCG can detect an early pregnancy A negative βhCG level rules out ectopic pregnancy 73-year-old male… Last week he went on safari in South Africa. On the way back in the plane he discovers pain in his right leg. During last night, sudden chest pain and breathing problems. Hyperventilation Cold skin, pale Low blood pressure Pulse 105 ECG shows right-heart stress Blood gas pH 7.22 ↓ pO2 6.7 kPa/ 50 mmHg ↓ pCO2 3.3 kPa/ 25 mmHg ↓ Hb 8.5 → sO2 0.92 % → Lactate 4.5 ↑ ? Which parameters? Myoglobin CKMB Troponin I NT-proBNP D-dimer CRP Pulmonary embolism D-dimer and blood gas support diagnosis CT scan shows big blood clot in right lung artery Treatment Thrombolysis (breakdown of blood clots) Heparin for six months What if... Myoglobin CKMB Troponin I NT-proBNP D-dimer CRP What if... Myoglobin CKMB Troponin I NT-proBNP D-dimer CRP AQT90 FLEX parameters Cardiac markers Infection marker Myoglobin CRP CKMB Troponin I Hemostasis marker NT-proBNP D-dimer Pregnancy marker ßhCG