Saliva test for MI diagnosis

[Richard B the EMT]

I'm still waiting for the hand held medical scanner Dr. McCoy uses on Star Trek.

As for that video, while what they discuss is probably accurate, that piece was a load of male bovine excrement!

[rock_shoes]

This has the potential to drastically change outcomes for patients. Particularly in rural areas where a 15 min transport time is considered extremely short. Also in areas suffering from "medic mill" syndrome. Everyone knows the shorter the event to balloon time the better.

[WelshMedic]

Learning to interpret an ECG is a basic ALS skill. I hate to think that this test will replace that.

WM

[Arctickat]

I doubt that it will replace anything, but it will enhance the ability to detect AMIs that the ECG might miss. Right side, posterior, and Non-STEMI would all have elevated cardiac enzymes and could be missed on a standard 12 Lead ECG. Pretty simple to use too. When I start an IV line I attach a piece of extension tubing, aspirate a ml or 2 with a syringe, then attach the IV tubing and flush the line. Viola, blood test completed with no time wasted for an added evaluation.

[rock_shoes]

Learning to interpret an ECG is a basic ALS skill. I hate to think that this test will replace that.

WM

I would never suggest removing ECG capability from the ambulance. I just think this kind of adjunct has the potential to be excellent.

[firedoc5]

If all this data is accurate, and IMHO test results become quicker with newer technology, it could be as useful as a Glucose meter. BUT should not eliminate the EKG, at least 3 lead. It would be a remarkable breakthrough.

But I was just wondering, how long after the MI occurs that the saliva starts to show those properties? Is it immediate or takes a specific time range?

Oh, and the Scrubs video...you know that show hit's home on so many different levels. I could be a writer for them.

[Arctickat]

The temporal release patterns of the three cardiac markers have significant differences, all three are useful tools in the determination of the source and timing of the onset of chest pain. Cell injury from AMI has been shown to result in a level of blood myoglobin above the upper limit of normal in approximately 2-3 hours after the onset of chest pain. Maximum concentrations are generally observed after 9-12 hours. CK-MB and troponin I are found in blood at elevated concentrations approximately 4- 6 hours after the onset of chest pain and peak at 12-24 hours. However, whereas CK-MB levels return to normal values in about 72 hours, troponin I levels remain elevated for up to 5-7 days. The use of these three markers is therefore complementary since they detect cardiac tissue damage over a wide range of times after myocardial infarction.

For this reason I prefer to use the test that provides results for all three, this gives me the opportunity to determine if the infarct is a new one or an older one.

[defib_wizard]

As a rural provider this test along with my assessment could change or alter my transport decision. Bypass the local hospital and transport to the cath lab 60 miles away. Or if Im on the far end of my area call for air transport. I don't think this will replace 12 lead interpretation but will enhance our capabilities.

[fallout]

I would love to have that test. My system has short transport but the area is very urban. Everybody has "gots the chests pains." Every shift I am presented with the asymptomatic, vital signs stable, 12-lead unremarkable chest pain patient. Consequently, the ER is very skeptical when you call a STEMI. I can't blame them entirely, medic mill + ton of non-cardiac chest pain and no one wants to call an inappropriate cath lab activation. If I was able to say "I have a positive saliva test," it would drill the message home to the ER staff that much better.

[UMSTUDENT]

Ooooh! I like this! As soon as I am done introducing myself -- before I even take vitals -- I'm getting a sputum sample and starting the process. By the time it's done, I will have vitals, a full history and physical, a 12-lead, and oxygen and IV established. At that point, I know whether or not I need to be headed to the cath-lab. Man, no matter how much this costs, it could save millions of dollars a year, and countless lives, as well as a lot of paramedic embarrassment.

Total win! :thumbright:

Agreed. Add to it the advances in field diagnostic technology. Dang engineers and their new fangled technology!

Definitely a believer that technology may well cause us to advance into the future faster than our own efforts.