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FACP. Colegio de médicos de Tarragona Nº 4305520 / fgcapriles@gmail.com




Sunday, November 15, 2015

Dolor toráxico

Resultado de imagen de JAMA
Fanaroff A; Rymer J; Goldstein S; Simel D; Newby K. JAMA. 2015;314(18):1955-1965. doi:10.1001/jama.2015.12735.
"Conclusions and Relevance 
Among patients with suspected ACS presenting to emergency departments, the initial history, physical examination, and electrocardiogram alone did not confirm or exclude the diagnosis of ACS. Instead, the HEART or TIMI risk scores, which incorporate the first cardiac troponin, provided more diagnostic information."
R.E.B.E.L.EM - 01 November 2014 - Bu Salim Rezaie 
"Every year there are 6 million visits to the Emergency Department (ED) for chest pain, and approximately 2 million hospital admissions each year. This is approximately about 10% of ED visits and 25% of hospital admissions with 85% of these admissions receiving a diagnosis of a non-ischemic etiology to their chest pain (CP). This over triage has enormous economic implications for the US health care system estimated at $8 billion in annual costs. 
Why do we do this? 
Well, it could be that the single greatest contributor to financial losses in malpractice claims against emergency physicians comes from failure to accurately diagnose acute myocardial infarction (AMI). 
So the question is: 
Are there specific aspects of the history that can increase or decrease the likelihood that a patient has acute coronary syndrome (ACS) and/or AMI? 
These were all fantastic articles looking at aspects of the history in helping aide us in clinical decision making, but none of these historical elements alone or in combination can reliably help us rule in or rule out ACS or AMI. Just remember that there are some historical elements (with negative and positive likelihood ratios) that we need to ask our patients to assist in risk stratification in conjunction with an EKG and cardiac biomarkers."