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Diapositive 1

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Diaphoresis. Swelling. Coughing. Fatigue. Hemoptysis. 4. Saves Lives! A rapid, multi-marker strategy is widely supported for AMI and CHF presenters ... – PowerPoint PPT presentation

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Title: Diapositive 1


1
Presentation
PRESENTED BY Eric-Allen Perreault
2
Symptoms Most Prevalent
3
Symptoms Most Prevalent
  • Chest Pain
  • S.O.B./Dyspnea
  • Diaphoresis
  • Swelling
  • Coughing
  • Fatigue
  • Hemoptysis

4
Rapid Diagnosis for S.O.B. and C.P.
  • Saves Lives!
  • A rapid, multi-marker strategy is widely
    supported for AMI and CHF presenters
  • Chest pain and dyspnea are frequent symptoms for
    patients presenting to the ED.
  • Coronary artery disease is the leading cause of
    death in the US, PE is ranked 3rd.
  • 10 of patients with PE die within 60 min
  • Treatments are available for patients that are
    appropriately diagnosed

5
Rapid Diagnosis for S.O.B. and C.P.
  • ED Overcrowding!
  • 5,669,000 ED visits/year for chest pain and
    related symptoms
  • 2 reason for visiting ED
  • 2,535,000 ED visits/year for shortness of breath
  • 7 reason for visiting ED
  • 1,551,000 ED visits/year for labored breathing
    (dyspnea)
  • 15 reason for visiting ED
  • Patients often have comorbities and unclear
    diagnosis

6
Rapid Diagnosis for S.O.B. and C.P.
  • Avoiding the Missed AMI Diagnosis!
  • AMI related chest pain is the leading symptom
    associated with medical malpractice claims.
  • S.O.B. is 2!
  • Patients often have comorbities and unclear
    diagnosis
  • Respiratory complaints are most common in
    patients seen alive in the ED who later die
    unexpectedly

7
Rapid Diagnosis for S.O.B. and C.P.
  • Improving the Bottom Line!
  • ACC/AHA, NACB guidelines and case studies clearly
    recommend and define benefits of a rapid
    diagnostic strategy
  • Used in conjunction with other clinical
    information, rapid measurement of B-type
    natriuretic peptide in the emergency department
    improved the evaluation and treatment of patients
    with acute dyspnea and thereby reduced the time
    to discharge and the total cost of treatment.
  • Christian Mueller, M.D. Use of B-Type Natriuretic
    Peptide in the Evaluation and Management of Acute
    Dyspnea NEJM Feb 2004
  • If an inexpensive test is available that
    eliminates a significant portion of the patients
    without DVT or PE, health care savings occur.
  • Richard A. Marlar, PhD Advance/Laboratory 2003
  • Our findings point to the fact that Triage
    Cardiac must be part of the basic equipment in
    the ED just as the ECG is.
  • Dr. Jean Pierre Rifler, SMUR, Montbard

8
Triage Profiler S.O.B.
  • Symptom Panel for Shortness of Breath Consists
    of
  • D-Dimer 100 ng/mL to 5000 ng/mL
  • XR BNP 5.0 pg/mL to 5000 pg/mL
  • Troponin I 0.05 ng/mL to 30 ng/mL
  • CK-MB 1.0 ng/mL to 80 ng/mL
  • Myoglobin 5.0 ng/mL to 500 ng/mL

9
What Does Profiler S.O.B. Do?
  • Deciphers the diagnostic dilemma of patients with
    dyspnea/Chest Pain
  • Should be the first draw in patients with dyspnea
    (or suspicion of pulmonary embolism) with or
    without Chest Pain
  • Panel will allow clinician to
  • Aid in diagnosis of AMI
  • Risk stratify ACS patients
  • Aid in diagnosis of CHF
  • Assess disease severity of CHF
  • Aid in diagnosis of PE and DVT

5 5 on 1 !
10
Value of the SOB Approach
11
Marker Interpretation First Draw
BNP
D-Dimer
TnI
CK-MB / Myo
Rule-In ACS/MI
Positive
Rule-Out PE/DVT
Rule-Out CHF
Negative
12
Triage ProfilER SOB
5
  • Indications
  • Tests
  • Patient

5
1
13
Analytical Sensitivity
  • The lowest concentration of each analyte that the
    assay can reliably detect
  • This is most relevant for a test like TnI than
    for BNP or D-dimer.
  • Any level of TnI may be considered abnormal
  • BNP and D-dimer are present in healthy
    individuals
  • As long as the cutoff is well above the limit of
    detection, the assay has sufficient sensitivity

D-dimer 100 ng/mL XR BNP 5 pg/mL Troponin
I 0.05 ng/mL CK-MB 1.0 ng/mL Myoglobin 5ng/mL
14
Interfering Substances
  • D-dimer is unaffected by other markers of
    coagulation

15
Analytical Specificity
  • As with the original assays on the panel, the
    D-dimer assay is able to measure D-dimer without
    interference by medications a patient may be
    taking.

16
Precision
  • Imprecision data for the other analytes on the
    panel are similar to that already reported

17
Is Your Test an ELISA?
  • (What is ELISA?)

18
ELISA / EIA
  • Enzyme-Linked Immunosorbent Assay
  • Synonymous with Enzyme Immunoassay (EIA)
  • 1st ELISAs were run in Microtiter plates (aka
    ELISA plates)
  • Member of a class of immunoassays
  • All involve capturing the analyte
  • All involve measuring captured analyte using a
    form of signal generator
  • ELISA uses an enzyme-labeled antibody or antigen
    to convert an invisible molecule into a
    visible molecule
  • Triage is an FIA that uses a fluorescent-labeled
    antibody or antigen as the signal
  • FIA can be just as sensitive as EIA (e.g., TnI)

19
Summary/Key Messages
  • The Triage Symptom Panel of Profiler S.O.B.
    provide additional tools an ED physician needs to
    answer the dyspnea and chest pain diagnostic
    dilemma
  • The ability to rapidly rule out PE and rule in or
    out AMI and CHF promises improved patient care,
    operational and economic benefits
  • The Triage Total Solution
  • Clinicians and Administrators
  • POC accounts
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