Diagnostic algorithm depends on age and history of known CAD
Erlanger protocol: all comers tested over 2 hrs, troponin and ckmb monitoring, EKG, clinical eval, serial rechecks...with troponin, if you go from normal to indeterminate on your delta trop that could be concerning and shouldn't be ignored.
No longer use ckmb testing
Do yourself a favor and get serial troponins -- a single troponin is potential useful after 6hrs, but often our patient population cannot tell you when the pain stopped accurately.
No two troponin I assays that have the same absolute values or cut off points -- a fundamental flaw to keep in mind
Using our Pretest Probability Calculator? You need n= 20-25 for it to be valid. Use it and document in your chart.
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