ABSTRACT
Current markers of myocardial injury lack specificity in patients with end-stage renal disease (ESRD). In particular, a false positive creatine kinase-MB (CKMB) elevation occurs in 5-10% of patients with ESRD. The aim of this study was to ascertain the relationship between CKMB and cardiac troponin I (cTnI), a new, highly sensitive and specific marker for myocardial injury, in the authors' dialysis population and compare their specificities. Blood samples were obtained from 112 dialysis patients (35 in peritoneal dialysis; 77 in hemodialysis). Patients were asymptomatic for cardiac ischemia and skeletal muscle injury. Mean +/- SD CKMB mass was 3.16 +/- 2.26 microg/L (range, 0.34-13.62), and cTnI was 0.025 +/- 0.061 ng/ml (range, 0.001-0.496). CKMB and cTnI levels did not correlate (r2 = 0.002; p = 0.61). CKMB mass concentration was significantly higher in men and in diabetics. No patient had a cTnI level greater than 1.5 microg/L, and eight asymptomatic patients had a CKMB mass greater than 6.7 microg/L. These data suggest a specificity of 100% for cTnI vs 94.6% for CKMB at these cutoff values. It is suggested that cTnI replace CKMB as a marker of myocardial injury in patients with ESRD.
Subject(s)
Creatine Kinase/blood , Renal Dialysis , Troponin I/blood , Female , Humans , Isoenzymes , Male , Middle Aged , Sensitivity and SpecificityABSTRACT
The response of the primary care physician in the initial assessment and management of acute arterial injuries will often be the deciding factor in survival of life, limb or organ system. Most arterial emergencies occur as a result of trauma, disruption of vessel wall and/or occlusion of flow. The common clinical syndromes of acute arterial emergencies are injuries to and beyond the aorta, acute aortic dissection, ruptured aortic aneurysm, and thromboembolic occlusive arterial disease. The role of arteriography and the urgency of definitive surgical repair in acute arterial emergencies is summarized.
ABSTRACT
The capabilities of individual hospital emergency departments participating in an emergency medical services system must be evaluated as the first step im improving the services in the region. By means of a weighted point-scoring method, personnel, facilities, equipment and organization can be assessed and the department categorized. This not only provides an evaluation of the present status of the department but also sets standards for improvement. Categorization provides the basis for regionalization of services, whereby each department has a defined responsibility to provide treatment of specified sophistication.
Subject(s)
Emergency Service, Hospital/standards , Equipment and Supplies, Hospital/standards , Evaluation Studies as Topic , Humans , Ontario , Personnel, Hospital/standards , Referral and ConsultationSubject(s)
Emergency Medical Services/standards , Physicians , Allied Health Personnel/education , Ambulances , Education, Medical, Continuing , Emergencies/therapy , Emergency Service, Hospital/standards , First Aid , Humans , Inservice Training , Medicine , Ontario , Specialization , Transportation of Patients , United States , WorkforceABSTRACT
Although the frequency of recognition of the syndrome of non-ketotic hyperosmolar coma is increasing in all age groups the mortality rate remains high. This paper reports the occurrence of this syndrome in a 12-year-old girl. The pathogenesis is discussed and a planned approach to the management of circulatory collapse, hypokalemia, hyperglycemia and hyperosmolarity over the initial 24 hours is proposed. The phenomenon of insulin resistance which was observed in this case is a rare complication of this syndrome. Awareness of the occurrence of this syndrome in all age groups, early recognition of its features and a planned approach to management are mandatory to reduce the very high mortality rate.
