The Mythbuster Is Facing Off With the Chief of Staff! by Yosef Leibman, M.D.
Wednesday, February 24, 2010 As we left the Mythbuster in the last blog, he was facing off with the chief of staff of St. We Never Change hospital. Dr. Pendergast has come to the rescue of his beleaguered surgical staff who fell from the evidence onslaught of the Mythbuster
The Mythbuster fires over the first salvo-
Doctor- are you waiting six hours for your repeat enzymes in chest pain patients? Better check out the delta test- that is, if you recheck your enzymes two hours after the first set you will see a change for the worse- see Ann Emerge Med 2004,44:12 and AJEM 2000 18:1.
Pendergast winced
Still using CPK MB because it is cheaper?- well some feel it doesn't work. Circulation 2008:1182200 noted it went up in asthma, PE, head trauma, muscle disease- all in the absence of heart disease. Won't help in renal failure- CPK MB goes up in that too. Troponin isn't the end all to be all either- often goes up in PE, and even in exercise. Ever thinking about going by clinical grounds alone?
Pendergast staggered.
Telling your EMS guys to put oxygen on all patients with chest pain? Did you know a meta analysis showed that this may increase infarct size and perhaps mortality? (Heart 2009 95:198) Oxygen causes reduced blood flow to the coronaries.
Pendergast started to look very woozy
Not allowed to shock asystole? Since 1992 the AHA has been saying no. But there is no evidence it does make a parasympathetic storm that will not allow heart restarting and since fine v fib maybe hard to pick up, there may be benefit to shocking it. (AJEM 26(9)618)
You are an educated man, Pendergast. All these articles came out within the last year and a half- you are interested in helping your patients.
Pendegast suddenly roared like wounded lion "Take this, mythbuster!" and he whipped out the ACC/AHA guidelines for unstable angina and STEMI. (JACC 50 e1-157) Mythbuster winced. He quickly turned to the Dogma Devastator and said " Did you mail for help?"
The devastator nodded.
Pendergast reached for the defibrillator and slowly turned towards the 'buster. Next time the last in the installment- will the mythbuster be toast?
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