Rapid determination of acute myocardial infarction using immunochemical detection of CK-MB in the emergency department

Abstracts Department. Renal colic was the most common mistaken diagnosis. Thus widespread unfamiliarity with the variable clinical picture of RAAA exists. Particularly in males over 55 years, the diagnosis should be considered if even one of the classic triad of abdominal or back pain, shock or a pulsatile abdominal mass are present.

101 EFFECTS OF SALINE INFUSION AND THE PNEUMATIC ANTISHOCK GARMENT ON HEMODYNAMICS, HEMORRHAGE AND SURVIVAL IN ABDOMINAL AORTIC INJURY Ali, J, Purcell, C. Vanderby. B. Department of Surgery, University of Toronto, Sunnybrook Medical Centre, Toronto, Ontario, Canada ln a pig model of infrarenal abdominal aortic injury we have previously demonstrated that death occurs within 15 minutes and that pneumatic antishock garment (PASG) inflation to an intraperitoneal pressure (I.P.) of 60 torr decreases hemorrhage and maintains survival for at least 1 hour. Utilizing the same model, 14 anaesthetized New Hampshire piglets had normal saline infused at a maximum rate of 200 ml/n-& in order to maintain baseline carotid artery blood pressure for 1 hour or until death occurred. Pulmonary artery, wedge and carotid artery blood pressures, cardiac output, and II? were monitored. Blood loss was measured at laparotomy. Seven animals (group I) had no PASG inflation while the other 7 (group II) had PASG inflation to an I.P. for 60 torr immediately after aortic hemorrhage began. Results (means f SD) are as follows (values in parenthesis are &om our previous study where no IV fluids were administered). +-~0.05 compared to group II, *pa.05 compared to previous study:

Group 1

Blood loss (ml) *+4840&1350(+1289&49)

Group 11

*1235*68(438*64)

Volume infused (ml) +54oof120

The following table summarizes the data for 0 and 3 hours, with sensitivity (Sens.) and specificity (Spec.) as noted METHOD coming Baxter Hybritech Tandem Hybritech ICON-QSR Helena REP

S+ns. (Ohr)Spec.(Ohr) 96.7% 54.8% 62.1 84.2

Sens.(3hr) 96.7 96.4

S;e$3vhr)

. 0 83.0

50.0

97.2

96.2

94.2

50.0 34.5

96.6 98.6

92.0 76.9

96.4 98.6

lmmunochemical determination of serial CK-MB levels provided a sensitive and specific method for detecting AMl in patients presenting to the ED within 3 hours compared to standard electrophoresis. As the hospital discharge diagnosis of AMI was based on electrophoretic analysis for CK-MB, it is possible some of the “false positive” determinations by the more sensitive immunochemical methods actually were due to myocardial injury. The ICON QSRTM method could determine the serum CK-MB method rapidly, requiring only eight minutes to perform. Rapid detection of AMl offers many potential advantages. Early diagnosis, while the patient is in the ED, would allow appropriate disposition of the patient with AMl to the intensive care setting. Potentially the diagnosis of AMl within a six hour period after symptom onset may allow thrombolytic therapy to be given to patients with AM1 not having diagnostic electrocardiograms.

535*180

Survival(min): Group I - *+28.0&X5(+9.5*4.2) GrouplI

emergency department (ED). Serum from 400 patients was collected and analyzed for CK-MB at 0 hours (presentation10 the ED) and 3 hours after presentation. After excluding transfer and ED discharge, data were available on 183 Patients. Standard World Health Organization criteria for AMl were used to establish the diagnosis of AMI in 31 of 183 patients after hospital discharge.

- >6Omins.

Attempts to maintain normal systemic arterial blood pressure with saline infusion increases abdominal aortic hemorrhage and survival both with and without PASG inflation; but survival was greater and hemorrhage was less with PASG inflation. 102 RAPID DETERMINATION OF ACUTE MYOCARDIAL INFARCTION USING IMMUNOCHEMICAL DETECTION OF CK-MB IN THE EMERGENCY DEPARTMENT Giblet, WB. Department of Emergency ,Medicine, University of Cincinnati Medical Center, Cincinnati, Ohio, USA Four immunochemical methods for detection of CK-MB and standard electrophoresis (Helena REP) were evaluated for their ability to diagnose acute myocardial infarction (AMI) in patients with chest pain presenting to a community hospital

81A PRESENTATIONS OF VICTIMS OF VIOLENCE TO SYDNEY’S INNER CITY TEACHING HOSPITAL’S EMERGENCY DEPARTMENT G.W.O. Fulde, M. Cuthbert, R. Kelly, F. Lovejoy, St. Vincent’s Hospital, Sydney, Australia The Emergency Department at St. Vincent’s Hospital, Sydney, Australia, has recently conducted the first study in Australia of violence as a cause of injuries in patients presenting to the Emergency Department. Over a six month period in 1989,512 victims of violence who presented to the Department were surveyed. As, up to now, Australian Data on violence ha come mainly horn police tiles, it was of particular relevance to note in this study that 57% of the victims mentioned had not reported the attacks to the police. An important fact to emerge which demonstrates the difference betseen Australian and American trauma, apart from demonstrating a less vioIent society, was that only 9% of injuries were caused by a knife or other sharp instrument - with the most usual site of injury being the head and neck (54%). The most common “weapon” was the assailant’s fist. Young single males were by far the most numerous victims