diagnosis | The St.Emlyn’s Podcast

Exploring the Latest in Emergency Medicine: February 2024 Edition

Hello and welcome to the St Emlyn's Podcast! I’m Simon Carly, and today, albeit a little later than planned, I'll be diving into the fascinating February papers and blogs that have graced the St Emlyn's Podcast. If you missed out in February, fear not—you can always revisit the archives on our blog. It’s all there, waiting for you to explore. Let’s take a deep dive into what made February such an exciting month in emergency medicine.

A Journey to Jeddah: Bridging Borders in Emergency Medicine

In February, I had the distinct honour of travelling to Jeddah, Saudi Arabia, to join the Saudi Arabian Society of Emergency Medicine. Jeddah is a city brimming with activity and change. Despite Saudi Arabia being vastly different from the UK, I found common ground with the emergency physicians there. Many of them have trained abroad in Canada, the US, and the UK, making them kindred spirits with shared values and ideas in treating emergency patients.

During my visit, I was invited to present the top ten trauma papers, a task I thoroughly enjoy. These papers, detailed on our website, included highlights like the PAMPER trial and airway management papers around cardiac arrest. We also delved into studies beyond trauma, such as the Airways 2 study on superox in critically ill patients and intubation with ED use of bougies, which we advocate at St. Emlyn’s. Additionally, the conservative management of pneumothoraces, a topic we've discussed before, is becoming increasingly recognized as safe, especially for traumatic pneumothoraces visible only on CT scans.

PTSD and the Road to Recovery: Insights from Rusty Carroll

Our friend and colleague, Rusty Carroll, has shared another compelling post on PTSD. Rusty’s previous blogs detailed his recovery journey from PTSD, stemming from his work in the ambulance service. His latest update brings us into his post-therapy life as he navigates a new, rewarding, and successful path. For anyone experiencing PTSD or knowing someone who is, Rusty's series is invaluable. His journey may differ from yours, but understanding that there is a path to recovery is incredibly encouraging.

PTSD is a serious issue that affects many healthcare professionals, and Rusty’s openness about his struggles and recovery provides a beacon of hope for others. His posts cover various aspects of his journey, from the initial recognition of symptoms to the therapeutic interventions that helped him reclaim his life. Rusty emphasizes the importance of seeking help, breaking the stigma associated with mental health issues, and supporting colleagues who may be going through similar experiences.

Understanding Trauma Mortality: A Shift in Focus

In our journal club, we explored why bleeding trauma patients die. This editorial by Karen Broe and John Holcomb in Critical Care Medicine challenges our preconceptions about trauma mortality. The implementation of pre-hospital systems, emergency management, and damage control surgery has significantly reduced pre-hospital deaths. However, this has shifted mortality to the emergency department's early hours and even later, 24 hours down the line.

We are now seeing deaths caused by late systematic immunosuppression, persistent inflammation, and catabolism syndromes. Despite successful initial management, patients are still succumbing later on. This shift indicates that our trauma story is far from complete. More research is needed to understand and address these late-phase deaths, suggesting that critical care phases hold the key to future advancements.

This new understanding prompts us to reconsider our approaches in trauma care. While we have made significant strides in reducing early mortality, the challenge now lies in managing these complex late-phase issues. This involves multidisciplinary collaboration, innovative research, and a commitment to continuous improvement in trauma care protocols.

Reevaluating PE in Syncope: A Fresh Perspective

Natalie May published a follow-up paper related to the PESIT study, which had previously suggested a high incidence of pulmonary embolism (PE) as a cause of syncope. This controversial study, conducted in Italy, sparked debates across various platforms, including EM Nerd, EMCrit, Emlyns Note, and Rebel EM.

However, new research from the North American Syncope Consortium reveals a much lower prevalence of PE among emergency department patients with syncope. This is a significant finding, as it challenges the alarming figures from the PESIT study. It allows us to return to our previous practices of using well-established tools like Wells' scoring and PERC scoring without the heightened fear of PE being the primary cause of syncope.

Natalie’s analysis provides a balanced perspective, highlighting the importance of context in interpreting study results. The discrepancy between the PESIT study and the North American Syncope Consortium's findings underscores the need for ongoing research and validation of clinical guidelines. As emergency physicians, staying informed about such developments ensures that we provide the best care based on the latest evidence.

Philosophy of Emergency Medicine: Workplace Relationships Matter

Stefan Brzezins contributes a thought-provoking post on the importance of workplace relationships. Stefan, a colleague who has worked in South Africa and now the UK, highlights how our interactions with colleagues significantly impact our behaviour, happiness, and departmental efficiency. Dysfunctional departments often correlate with poor personal relationships among consultants and senior nurses, ultimately affecting patient care.

Stefan's advice includes not taking unnecessary offence, showing gratitude, celebrating the good news, and fostering teamwork. While these may seem obvious, their implementation can transform workplace dynamics. Reflecting on Stefan's insights has prompted me to reevaluate my practices and strive for better interpersonal relationships at work.

Good workplace relationships are foundational to creating a supportive and effective healthcare environment. When colleagues communicate openly, show appreciation for each other’s efforts, and work collaboratively, they experience higher job satisfaction, reduced stress, and, ultimately, better patient outcomes. Stefan’s post serves as a reminder that the human element of healthcare is just as important as the clinical skills we bring to our practice.

Ventilation During RSI: Revisiting Established Practices

Another significant post examines whether we should continue ventilation during rapid sequence intubation (RSI). Traditional teaching discouraged ventilation during the apnea period due to safety concerns. However, for critically ill patients with low oxygen saturation, not ventilating can lead to severe hypoxia.

A randomized control trial in the ED assessed the safety of ventilation during this period. The study found that patients who were ventilated during the apnea period had less oxygen desaturation without significant adverse effects. While the study's sample size is small, it supports our evolving practices and aligns with our experiences. However, it is crucial to critically assess the study's methodology and incorporate this knowledge cautiously into clinical practice.

This trial’s findings challenge the long-standing dogma of no ventilation during RSI, pushing us to rethink and potentially update our protocols. As emergency medicine evolves, we must remain flexible and willing to adapt our practices based on emerging evidence. Ensuring that our approaches are both safe and effective is paramount to improving patient outcomes.

The Role of Scribes in the ED: Efficiency and Quality Improvement

Chris Gray's post on the use of scribes in the ED follows a previous discussion on this topic. Scribes can save time and improve documentation quality, which is vital in a high-pressure environment. A randomized control trial demonstrated that scribes do save time, though the effect size was modest. The potential for better documentation quality is equally important, making scribes a valuable addition to emergency departments. We are keen to hear from anyone using scribes in the UK, as this practice is more common in the US.

The use of scribes can enhance the efficiency of emergency departments by allowing physicians to focus more on patient care rather than administrative tasks. Improved documentation can also lead to better patient tracking, follow-up, and overall care quality. As our healthcare systems become increasingly strained, innovations like scribes offer practical solutions to maintain high standards of care.

Reflecting on February: A Busy Month in Emergency Medicine

February was packed with insights and developments in emergency medicine. From international collaborations and trauma management advancements to revisiting PTSD recovery stories and philosophical reflections on workplace relationships, the month offered a wealth of knowledge. As we move into March, we look forward to sharing more exciting updates, including coverage of the SMACC conference.

The diversity of topics covered in February highlights the multifaceted nature of emergency medicine. Each paper and blog post contributes to a broader understanding of how we can improve patient care, support our colleagues, and adapt to new challenges. This continuous learning process is what makes emergency medicine such a dynamic and rewarding field.

Supporting the St Emlyn's Podcast: Your Contribution Matters

Since 2012, we've funded the blog and podcast out of our own pockets. As our audience grows, so do our expenses. If you find our content valuable and wish to support us, please consider making a small donation or subscribing regularly. Your contributions help us keep St Emlyn's a free, open-access medical education resource for all.

By supporting the St Emlyn's Podcast, you enable us to continue delivering high-quality, evidence-based content to the emergency medicine community. Your donations help cover the costs of hosting, producing, and distributing our materials, ensuring that we can reach a global audience of healthcare professionals.

Conclusion

The February edition of the St Emlyn's Podcast provided a rich tapestry of insights and developments in emergency medicine. From my journey to Jeddah and the fascinating trauma studies to the personal stories of PTSD recovery and the philosophical reflections on workplace relationships, there was something for everyone.

Our exploration of new research, such as the reevaluation of PE in syncope and the safety of ventilation during RSI, underscores the importance of staying informed and adaptable in our practice. Meanwhile, discussions on the role of scribes and the significance of workplace dynamics highlight the multifaceted challenges we face in emergency medicine.

As we look forward to March and beyond, we remain committed to bringing you the latest in emergency medicine and fostering a community of continuous learning and improvement. Thank you for joining us on this journey, and we appreciate your support in keeping St Emlyn's a vital resource for all.

Stay tuned for more insights, updates, and discussions. Until then, keep pushing the boundaries of emergency medicine, supporting your colleagues, and striving for excellence in patient care. Have a great time, and we’ll be back with you shortly.

Exploring the Latest in Emergency Medicine: February 2024 Edition

A Journey to Jeddah: Bridging Borders in Emergency Medicine

PTSD and the Road to Recovery: Insights from Rusty Carroll

Understanding Trauma Mortality: A Shift in Focus

Reevaluating PE in Syncope: A Fresh Perspective

Philosophy of Emergency Medicine: Workplace Relationships Matter

Good workplace relationships are foundational to creating a supportive and effective healthcare environment. When colleagues communicate openly, show appreciation for each other’s efforts, and work collaboratively, it leads to higher job satisfaction, reduced stress, and ultimately better patient outcomes. Stefan’s post serves as a reminder that the human element of healthcare is just as important as the clinical skills we bring to our practice.

Ventilation During RSI: Revisiting Established Practices

The Role of Scribes in the ED: Efficiency and Quality Improvement

Reflecting on February: A Busy Month in Emergency Medicine

Supporting the St Emlyn's Podcast: Your Contribution Matters

Conclusion

Shortness of breath, or dyspnoea, is an alarming symptom because it can signify a wide range of serious conditions. From acute respiratory diseases to cardiac emergencies, the differential diagnosis is vast. For new doctors, encountering a patient with dyspnea can be particularly challenging due to the multitude of potential causes and the urgent nature of the symptom.

Prioritising Life-Threatening Conditions

In the ED, our primary focus is to rule out the most serious conditions first. This approach ensures that we address potentially fatal diagnoses promptly. The key life-threatening causes of shortness of breath include:

Asthma and COPD Exacerbations
Pneumonia
Left Ventricular Failure (LVF)
Pulmonary Embolism (PE)
Pneumothorax

These conditions require immediate attention and demand different management strategies. Let's break down each one and discuss the clinical approach.

Initial Stabilisation: Oxygen Therapy

When a patient presents with shortness of breath, one of the first steps is to administer oxygen. This intervention is typically beneficial, as it addresses potential hypoxia, a common denominator in many serious conditions. While long-term oxygen therapy may have contraindications in specific situations, such as COPD exacerbations, the immediate goal is to stabilize the patient.

Resuscitation and Monitoring

For patients with severe dyspnea, resuscitation measures might be necessary. These individuals should be placed in a monitored area with nursing support and close physician oversight. In cases where respiratory distress is evident, ensure that resuscitation equipment and personnel are readily available.

Taking a Detailed History and Performing a Physical Examination

History Taking

A thorough history is critical in identifying the underlying cause of shortness of breath. Key aspects to explore include:

Past Medical History: Conditions such as asthma, COPD, heart failure, or previous PE episodes are crucial.
Symptom Onset and Progression: Sudden onset may suggest PE or pneumothorax, while a more gradual progression could indicate chronic diseases.
Associated Symptoms: Fever might point towards an infectious process like pneumonia, while chest pain could suggest PE or myocardial infarction.

It's also helpful to ask the patient if they have experienced similar symptoms before. This question can provide immediate insight, especially if the patient has a known condition like LVF.

Physical Examination

The physical examination should be comprehensive, focusing on:

Respiratory Rate: Tachypnea is a red flag and often correlates with the severity of the underlying condition.
Heart and Lung Sounds: Wheezing, crackles, or diminished breath sounds can help differentiate between asthma, COPD, pneumonia, and heart failure.
Peripheral Signs: Look for indications of DVT, cyanosis, or edema, which can suggest cardiac or thromboembolic etiologies.

Diagnostic Testing and Imaging

Initial Tests

Electrocardiogram (ECG): Essential for detecting cardiac causes such as ischemia or arrhythmias.
Chest X-Ray: A quick and non-invasive tool to identify pneumonia, pneumothorax, heart failure, or pleural effusions.
Arterial Blood Gas (ABG): Useful for assessing oxygenation and ventilation status, particularly in acute cases. Using local anesthetic can alleviate the discomfort associated with ABG sampling.

Advanced Imaging

CT Pulmonary Angiography (CTPA): The gold standard for diagnosing PE, particularly when clinical suspicion is high.
Point-of-Care Ultrasound (POCUS): Increasingly used to evaluate lung pathology, assess for pleural effusions, and gauge cardiac function.

Tailoring Treatment to Specific Diagnoses

Asthma and COPD Exacerbations

Bronchodilators: Administer via nebulizers or metered-dose inhalers with spacers.
Corticosteroids: Often necessary to reduce airway inflammation.

Pneumonia

Antibiotics: Initiate early, especially in septic patients, to combat bacterial infections.
Supportive Care: Including fluids for hydration and fever management.

Left Ventricular Failure

Diuretics: Administer to reduce fluid overload and alleviate pulmonary congestion.
Vasodilators: Consider in cases of severe hypertension or acute pulmonary edema.

Pulmonary Embolism

Anticoagulation: Essential for preventing further clot formation.
Thrombolysis: Consider in cases of massive PE with hemodynamic instability.

Pneumothorax

Needle Decompression: Required for tension pneumothorax, followed by chest tube insertion.
Observation or Chest Tube: Depending on the size and symptoms of a simple pneumothorax.

Monitoring and Reassessment

Continuous monitoring is vital for patients presenting with shortness of breath. Vital signs, including oxygen saturation and respiratory rate, should be closely observed. Frequent reassessment allows for timely adjustments in the treatment plan, ensuring optimal patient outcomes.

The Importance of Senior Support and Collaborative Care

In the ED, working alongside senior colleagues and consulting other specialties can significantly enhance patient care. Junior doctors should proactively seek guidance, especially in complex or uncertain cases. This collaborative approach not only enhances patient safety but also serves as a valuable educational experience.

Developing a Systematic Approach

Dealing with shortness of breath can be stressful, especially when the cause is not immediately apparent. Developing a systematic approach, or mental model, can help clinicians efficiently manage these cases. Practicing this approach mentally, perhaps during a commute, can prepare one for real-life scenarios. This mental rehearsal fosters a more confident and effective response when faced with an actual patient.

Conclusion

Shortness of breath is a common yet potentially life-threatening symptom that demands a structured and thorough approach. By prioritizing the exclusion of critical diagnoses, employing appropriate diagnostic tools, and initiating targeted treatments, emergency physicians can significantly improve patient outcomes. Remember, early intervention and continuous monitoring are key, as is the willingness to consult senior colleagues and use available resources.

For more detailed discussions and educational resources, visit our blog site. Keep learning, stay curious, and continue to provide compassionate care to all patients. Thank you for joining us on the St. Emlyn's podcast. We look forward to sharing more insights and discussions in future episodes. Good luck in your practice, and always strive to heal the sick! See you soon!

Summary

Shortness of breath is a common yet potentially life-threatening presentation in the emergency department. A structured approach to assessment and management, including a thorough primary survey, focused history, physical examination, and targeted investigations, is essential. Early initiation of oxygen therapy, appropriate use of diagnostic tools, and timely management of underlying conditions can significantly impact patient outcomes. Collaboration with senior colleagues and continuous education through simulation and practice are key to improving care for these patients.

The Importance of Thorough Evaluation

Headaches can be tricky. Many patients experience them as part of various symptomatologies, but our focus here is on those for whom headache is the primary complaint. Our objective is to rule out serious conditions while providing effective management. The major diagnoses to consider include subarachnoid haemorrhage, meningitis, brain tumours, and temporal arteritis.

Subarachnoid Hemorrhage: A Critical Diagnosis

Every emergency physician must be vigilant about subarachnoid haemorrhage (SAH). The classic presentation is a sudden-onset severe headache, often described as being hit on the back of the head with a baseball bat. However, not all patients present with this textbook description. Many just report an incredibly severe headache, sometimes developing over minutes rather than instantaneously.

In such cases, the threshold for investigation should be low. Studies indicate that about 10% of patients presenting to the ED with headaches have a potentially life-threatening condition such as SAH, tumor, or meningitis. This high hit rate underscores the importance of being thorough. Early CT scans are critical. They are more diagnostic the earlier they are performed, and a negative CT can often effectively rule out SAH.

Meningitis: A Subtle but Deadly Threat

Meningitis is another serious condition that can cause a headache. The classic signs include a recent infection, high temperature, neck stiffness, and altered consciousness. However, like SAH, meningitis doesn’t always follow the textbook. Patients may present with milder symptoms, such as neck pain without severe rigidity or general discomfort with light without pronounced photophobia.

Blood tests like white cell count and CRP are not always reliable when considering meningitis. The absence of abnormalities doesn’t rule out the disease. Therefore, empirical treatment with antibiotics is often warranted if there’s any suspicion of meningitis. It’s better to administer antibiotics and later find out they weren’t necessary than to miss a diagnosis and face dire consequences.

Brain Tumors: The Silent Intruders

Brain tumours can present subtly, often with non-specific signs like headaches, which can be easily overlooked. First-time seizures in young adults are a common presentation that warrants a thorough evaluation for tumours. CT scans are typically sufficient to detect most tumours, although in some cases, additional imaging such as MRI or CT angiography may be necessary.

Temporal Arteritis: A Vision-Saving Diagnosis

Temporal arteritis is another condition to consider, particularly in patients over 50. Symptoms include headache, jaw claudication, and visual disturbances. Blood tests such as ESR and CRP are useful here. Early treatment with steroids can prevent irreversible vision loss, making prompt diagnosis and intervention crucial.

Managing Migraines in the ED

Migraines are a common yet often overlooked cause of severe headaches that bring patients to the ED. While not life-threatening, they can be debilitating. Effective management involves hydration, analgesics, anti-emetics, and sometimes 5HT3 receptor antagonists. It’s important to distinguish between first-time migraine presentations and recurrent migraines, especially in older patients, to rule out more serious underlying conditions.

The Role of CT Scans in Headache Management

The advent of CT scanning has revolutionized the management of headaches in the ED. Today, the threshold for performing a CT scan is much lower than it was 15 years ago. Despite concerns about radiation, the benefit of identifying serious conditions outweighs the risks, particularly when about 10% of patients have significant pathology.

Practical Tips for Junior Doctors

For junior doctors, it’s essential to involve senior colleagues in the evaluation and management of patients presenting with headaches. Discussing cases with experienced physicians helps in understanding the rationale behind investigations and management decisions. This collaborative approach ensures comprehensive care and aids in professional development.

Conclusion

Managing headaches in the emergency department requires a careful, systematic approach to rule out life-threatening conditions while providing effective symptom relief. Subarachnoid haemorrhage, meningitis, brain tumours, and temporal arteritis are critical diagnoses that must not be missed. Early CT scans, judicious use of blood tests, and prompt empirical treatment when necessary are key strategies. Remember, thorough evaluation and timely intervention can significantly improve patient outcomes.

Welcome to the St. Emlyn's podcast! In this episode, we're exploring the fascinating world of troponins, vital biomarkers essential for diagnosing myocardial injury. Whether you're a seasoned clinician or a medical student, understanding troponins is crucial for effective patient care. We'll cover everything from the basics to advanced concepts, ensuring you have a comprehensive grasp of this critical topic.

What are Troponins?

Troponins are proteins found in muscle tissue, playing a key role in muscle contraction. Often misunderstood as cardiac enzymes, troponins are actually proteins involved in the contractile apparatus within muscle cells. They exist in three forms: Troponin I, Troponin T, and Troponin C, which work together within muscle fibers to regulate muscle contractions.

Why are Troponins Important in Cardiology?

Troponins are crucial biomarkers for diagnosing myocardial injury. When heart muscle is damaged, troponins are released into the bloodstream. This release can occur due to various conditions, including myocardial infarction (heart attack) and other forms of stress on the heart. Measuring troponin levels in the blood helps clinicians determine the extent of myocardial injury and make informed decisions about patient care.

The Difference Between Cardiac and Skeletal Troponins

Troponins are present in both skeletal and cardiac muscle. However, cardiac-specific isoforms of Troponin I and Troponin T can be detected through blood tests, allowing clinicians to specifically identify myocardial damage. This specificity is a significant advancement over previous markers like CK, LDH, and ALT, which were not cardiac-specific and took longer to rise in the bloodstream.

When are Troponins Released into the Blood?

Troponins are released into the bloodstream when there is myocardial injury. This injury can result from various causes, such as acute myocardial infarction, physical stress, or other conditions that strain the heart. Understanding that troponins indicate myocardial injury rather than just myocardial infarction is crucial for accurate diagnosis and treatment.

The Kinetics of Troponin Release

Following myocardial injury, troponin levels typically peak in the blood within 12 to 24 hours. The time it takes for troponin levels to fall depends on several factors, including the severity of the injury, the patient's renal function, and whether there is ongoing troponin release into the blood. For example, patients with significant myocardial infarction might take weeks to clear troponins from their bloodstream, while those with smaller injuries might clear them within a day.

Troponins and Renal Failure

A common question is whether troponin tests are useful in patients with renal failure. The answer is a resounding yes. Although patients with renal failure may have elevated baseline troponin levels due to reduced clearance, troponin testing remains a valuable diagnostic tool. It's essential to interpret these levels in the context of the patient's renal function and look for trends in troponin levels through serial testing.

Understanding Troponin Assays

Troponin tests are immunoassays, which means they use antibodies to target specific parts of the troponin molecule. These antibodies are attached to a signal that emits light, allowing for the quantification of troponin levels in the blood. While lab-based assays are highly accurate, point-of-care testing devices are also available, though they may not be as sensitive or precise as lab tests.

The Role of Point-of-Care Testing

Point-of-care testing devices, such as handheld analyzers, offer quick results and can be used at the bedside. However, they may not match the sensitivity and precision of lab-based assays. Some portable devices provide qualitative results, similar to a home pregnancy test, while others offer quantitative measurements. Clinicians should be aware of these differences and use point-of-care devices appropriately.

Analytical vs. Diagnostic Sensitivity

When discussing troponin assays, it's crucial to differentiate between analytical sensitivity and diagnostic sensitivity. Analytical sensitivity refers to the assay's ability to detect low concentrations of troponin reliably. In contrast, diagnostic sensitivity pertains to the assay's ability to correctly identify patients with the condition being tested for, such as acute myocardial infarction. High-sensitivity troponin assays have improved both analytical and diagnostic sensitivity, enabling earlier and more accurate diagnosis.

Timing of Troponin Testing

In the UK, troponin testing typically starts from the time of symptom onset. This approach differs from other countries where testing begins upon the patient's arrival in the emergency department. The timing of troponin testing is crucial, as early testing can lack sensitivity. Serial sampling over several hours helps ensure accurate diagnosis, with a common practice being to test initially and then again at intervals such as six, ten, or twelve hours after symptom onset.

Interpreting Troponin Levels in Clinical Practice

Interpreting troponin levels requires considering the clinical context and pre-test probability. A positive troponin test in a patient with low pre-test probability of myocardial infarction may not indicate a true positive. Conversely, a negative test in a high-risk patient does not entirely rule out disease, especially if there is potential for a late troponin rise. Clinicians must integrate troponin results with other diagnostic information to make informed decisions.

Troponins in Renal Failure

Patients with renal failure often have elevated baseline troponin levels due to impaired clearance. However, troponin testing remains valuable for diagnosing myocardial injury in these patients. It's essential to understand the baseline level for each patient and focus on changes in troponin levels over time, rather than a single measurement. Serial sampling helps differentiate chronic elevation from acute myocardial injury.

Diagnosing Unstable Angina

It's important to recognize that unstable angina can occur without elevated troponin levels. These patients may not show a rise and fall in troponin but still have significant coronary artery disease that requires attention. Clinical judgment, along with other diagnostic tools like ECG and patient history, is vital in diagnosing and managing unstable angina.

Key Takeaways for Clinicians

Troponins are proteins involved in muscle contraction and are critical biomarkers for diagnosing myocardial injury.
Cardiac-specific isoforms of Troponin I and Troponin T are used to detect myocardial damage through blood tests.
Troponins are released into the blood following myocardial injury, not just myocardial infarction.
The timing of troponin testing is crucial, with serial sampling providing more accurate results.
Point-of-care testing devices offer quick results but may lack the sensitivity and precision of lab-based assays.
Interpreting troponin levels requires considering the clinical context and pre-test probability.
Troponin testing is valuable in patients with renal failure, focusing on changes in levels over time.
Unstable angina can occur without elevated troponin levels, requiring careful clinical evaluation.

Conclusion

Understanding troponins and their role in diagnosing myocardial injury is essential for clinicians. From the basics of what troponins are to the nuances of interpreting test results, this knowledge is crucial for providing the best care to patients with suspected cardiac conditions. Stay tuned for our next episode, where we'll delve deeper into high-sensitivity troponin assays and their impact on emergency medicine.

For any questions or further discussion, feel free to comment on the blog post or email us. We're here to help and look forward to continuing this conversation. Until next time, take care and keep learning!

This blog post is brought to you by the team at St. Emlyn's, dedicated to providing high-quality education and resources for emergency medicine professionals.

Episodes

St. Emlyn's April 2019 Podcast Highlights

Andromeda Shock Trial: A New Perspective

Enhancing Learning with Minimal Effort

Aortic Emergencies: Key Insights from George Willis

Ambulatory Care for PEs: Dan Horner's Expert Insights

Coping with Clinical Tragedies: Liz Crowe's Personal Journey

Final Thoughts

Highlights from March 2019: Key Insights and Updates

Management of Adult Congenital Heart Disease

Common Issues in ACHD Patients

Key Takeaways for Emergency Physicians

A Deeper Dive into Fontan Circulation

Top Trauma Papers from the Trauma UK Conference

The PAMPer Trial

Bougie Use in the ED

Late Presenting Head Injury Patients

The Zero Point Survey

Responsible Volunteering Overseas

The Ethics of Volunteering

Volunteering Responsibly

Case Study: Volunteering in South Africa

The Future of SMACC: CODA

CODA: A New Beginning

Looking Ahead

What to Expect from CODA

Additional Highlights from March

Critical Appraisal Nuggets (CANS) on P-values

Dual Coding in Medical Education

The Impact of Reboa in Trauma Care

The Role of Evidence-Based Practice

Final Thoughts

Stay Connected

Reflecting on 2018: Transformational Reads and Achievements

Goals for 2019: Innovations and Personal Aspirations

New Year’s Resolutions: Insights from Liz Crowe

Tetanus Guidelines: New Insights and Practical Applications

Excellence in Emergency Medicine: Claire Richmond’s Contributions

Prognosticating Cardiac Arrest Outcomes: Dan Horner’s Research

Celebrating Evidence-Based Medicine: Critical Appraisal E-Book

Pre-Medication for Ketamine Sedation: Exploring New Research

HEMS and Traumatic Cardiac Arrest: Evaluating Outcomes

Looking Ahead: Plans for the Future

Support St. Emlyn’s: Keeping Education Free and Accessible

Understanding High Sensitivity Troponins: A Guide for Emergency Physicians

Introduction to High Sensitivity Troponins

Analytical Sensitivity vs. Diagnostic Sensitivity

High Sensitivity Troponin Assays: A Closer Look

The Balance Between Sensitivity and Specificity

Using High Sensitivity Troponins in the Emergency Department

Practical Considerations for Emergency Physicians

Future Directions and Guidelines

Conclusion

Prioritising Life-Threatening Conditions

Initial Stabilisation: Oxygen Therapy

Resuscitation and Monitoring

Taking a Detailed History and Performing a Physical Examination

History Taking

Physical Examination

Diagnostic Testing and Imaging

Initial Tests

Advanced Imaging

Tailoring Treatment to Specific Diagnoses

Asthma and COPD Exacerbations

Pneumonia

Left Ventricular Failure

Pulmonary Embolism

Pneumothorax

Monitoring and Reassessment

The Importance of Senior Support and Collaborative Care

Developing a Systematic Approach

Conclusion

Summary

The Importance of Thorough Evaluation

Subarachnoid Hemorrhage: A Critical Diagnosis

Meningitis: A Subtle but Deadly Threat

Brain Tumors: The Silent Intruders

Temporal Arteritis: A Vision-Saving Diagnosis

Managing Migraines in the ED

The Role of CT Scans in Headache Management