Saliva test for MI diagnosis

[cynical_as_hell]

This could be a great tool for the ER, but it really doesn't mean much to EMS. 15 minutes is too long to wait around and see if there is a problem. Most agencies can have their patients to the ER by then. But, if this saliva test really does work, than it will make bank because alot of people do have silent heartattacks.

[UMSTUDENT]

This could be a great tool for the ER, but it really doesn't mean much to EMS. 15 minutes is too long to wait around and see if there is a problem. Most agencies can have their patients to the ER by then. But, if this saliva test really does work, than it will make bank because alot of people do have silent heartattacks.

I imagine the time can made faster. Given advances in computer technology, the only time limitation I see is the time it takes for the actual chemical assay to occur. The computer reading the results is probably fairly instant.

Besides, 15 minutes is not meaningless. Most calls from time of contact to the time they reach the ED are probably in the realm of at least 20 minutes. In rural/suburban settings like where I work you can easily spend 20 minutes on scene performing a 12-Lead, establishing an IV, and extricating from the house. We have this belief in EMS that we need to run, run, run to the hospital, when the opposite is actually quite true. The time saved on scene from taking a saliva swab that could confirm elevated cardiac enzymes in tremendous.

Like most of our problems, we would just need to re-educate.

[Arctickat]

The tests that I use actually give results in about 5 minutes and should not be used as a reference after 20 minutes, but as I have stated before, they are blood tests, not saliva. I never wait around to make a transport decision based on this blood test, but it is always ready by the time I radio into the ER with my report. Usually what I do is a small blood draw off the IV start. If the patient doesn't warrant an IV start, then I don't do the blood test.

[speedygodzilla]

I wonder if this is going to replace the blood test done in the hospital. Does it test for the same cardiac enzymes and is it just as accurate or better? I know at the ER I work at the lab takes around 20 minutes or more with blood, so if this could be done before the pt even gets to the ER by us that would be great. Is the test going to show positive or elevated for someone who has a damage heart from the past? I have a lot of questions about this but am excited to hear of the possibilities.

[Arctickat]

I don't think it will replace the blood tests in the hospital at any time in the foreseeable future. These tests are qualitative, not quantitative, but I can see them being used in the field as regularly as an ECG.

The most comprehensive test I have provides positive readings if:

Cardiac Troponin I exceeds 1.5ng/ml

CK-MB exceeds 5ng/ml

Myoglobin exceeds 50ng/ml

A positive reading is indicated by the simple appearance of a line for the control and one for each marker, a negative reading by the appearance of only the control line.

My understandings of cardiac markers is that they take some time to appear and return to normal. I believe I have a previous post in here regarding the time it takes for this to occur. These tests will provide positive results only if each of these markers is present in the blood stream at sufficient levels as noted above. Any of these levels indicates muscle damage, especially the troponins.

PM me if you'd like further information, I can send you to the website of my supplier.

[island emt]

15 Minutes?? What if the majority of your transports are under 10?? Seems a bit long. I'll invest more interest when its instant

And of course, what is the cost/benefit?

We've got peoples driveways that take more than 15 minutes to travel down & then between 30 minutes and an hour transport to the hospital

This type of spot testing for cardiac indicators could potentially make a big difference in survivability of non atypical MI's

[firedoc5]

I know it may have been mentioned, but I'm too lazy too go look, but, what is the cost. Or at least the potential costs if it hits the market?

[Arctickat]

About 6 bucks for the TnI test and 25 bucks for the combined TnI, CK-MB, and Myoglobin

[tniuqs]

I don't think it will replace the blood tests in the hospital at any time in the foreseeable future. These tests are qualitative, not quantitative, but I can see them being used in the field as regularly as an ECG.

The most comprehensive test I have provides positive readings if:

Cardiac Troponin I exceeds 1.5ng/ml

CK-MB exceeds 5ng/ml

Myoglobin exceeds 50ng/ml

<snip>

PM me if you'd like further information, I can send you to the website of my supplier.

A Question raised with all of this very interesting thread line, (sans the TV medicine) bedside troponin has been used for more than 6 years (blood test variety) that I know of in ICU/CCU as it is far faster when the lab is less than "stat" the saliva tests are the new kid on the block from my understanding are being developed for a plethora of "tests" recreational drug field testing the major focus .. thanks but I sure want to stay away from that item ... I hate courts and I have Lawyerphobia.

A point being is that we as EMS providers can test all we want but does it really benefit the patient or change treatment modalities in the vast majority of cases ... and going the cost effective disscussion here.

1- For a short hop in an urban enviroment, IMHO not really, with the present trendy concept to door rescueplasty asap .. that said if one is in that situation and has that option available.

2- For the more rural or long distance transport hell yea ... this sounds great if its not delaying transport but seriously but unless you are carrying thromolyitics is there really a point to doing more field diagnostics that will be repeated in the ER for liability reasons.

3- I suspect its where one is very remote and has the capability to use thrombolyics and all the goodies ... well go for it, thats where I enjoy working the most.

Second query just what regular service in Canada is even attempting this routine bedside Troponin ? heck out west very few progressive services even carry clot busters because they are but typically are too "close in" and only rare occassions do they even attempt to contact medical control until their rolling in the gut wagon. With the MDs wanting to see for themselves before they push TNKase.

Now Bedside Myoglobin would be a great multi use bedside test, although most on this website (with that comment) would know what patient it could be important diagnosic factor but I hardly think a spit test for that one just yet ... sorry rambling.

cheers

[Arctickat]

All good points tniuqs, but here's how I see it. Over the past five decades, EMS has progressed from the meatwagon system to one of highly trained professionals who are able to provide advanced medical skills to the patient to save lives. Treatments commonly performed in hospital have trickled down over time to be done in the ambulance. As technology becomes available, smaller, and more portable it tends to make its way to the ambulance. Defibrillators, IV punps, and transport ventilators are all such examples.

As technology continues to evolve into the EMS field, so to do the treatments a medic is able to provide. What did we do with hypoglycemics before we could do a blood glucose check in the field? Many EMS jurisdictions want to use thrombolytics in the field but the powers that be are still reticent because they don't feel a medic has the adequate training to interpret a 12 lead and if one should be sent to the cardiologist for confirmation, the cardiologist still doesn't get the whole picture; also, consider the time this takes to complete. Fax 12 lead, hospital tracks down doc, he reads the 12 lead and gets back to you. Having the ability to conduct a prehospital lab test, whether by ISTAT or the less expensive IVDDs provides one more weapon in the medics arsenal to confirm or disprove the presence of a myocardial infarct. It may even be considered that the medic will then have enough information to be able to determine if thrombolytics are appropriate and have them added to the protocol without having to consult a cardiologist...med control of course, but not the specialist. The problems with the ISTAT is the cost, that the cartridges have to be refrigerated, and it can only do one test at a time. 10 minutes for trops, another 10 for CK-MB, and so on. The IVDDs can do all three in 5 minutes, can be stored at room temp, and have a 2 year shelf life.

Studies listed at AHA and medscape confirm that giving thrombolytics sooner is better than later, the Assent III plus is one example. ExTRACT-TIMI 25 is another. To have the added tool to confirm that it is being used properly is just one more piece of technology that will advance prehospital care.