Transcript AQT90 FLEX parameters

AQT90 FLEX parameters
06/07/2015
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