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Discussion: Mobile Blood Analyser making a difference

We have been testing a mobile blood analyser in our ambulances in the Borders, in partnership with the Scottish Centre for Telehealth and Telecare (SCTT), NHS Borders and Samsung. Our Paramedics use a mobile unit, provided by Samsung, to take a blood sample from cardiac patients and run a test for troponin in the ambulance while en route to hospital.  (Troponin is a cardiac marker found in the blood following damage to the heart muscle caused by a heart attack.)  The test differentiates between a heart attack and angina. The early availability of this information enables ambulance crews to deliver the most clinically effective care en route to hospital for patients.

How do you see this type of equipment working in your community?


Will this allow crews to thrombolyse patients who are pain free based on ECG and Troponin results alone? Will crews thrombolyse based on Troponin results alone if there are no significant ECG changes? f the answer to either of these questions is Yes, and the clinical decision making is with the Paramedic then it would be a helpful tool in delivering clinically effective treatment. If however, the results are relayed some how (hopefully not relying on mobile phones alone as it is remote and rural areas that could benefit most from this), and decisions to Thrombolyse (or not) taken by a Health professional who is remote from the patient then I am less convinced. Will the referral be to a senior medical professional? If it's a cardiac nurse who is making the ultimate decision and taking accountability for the decisions? Can a remote person take accountability for that decision making? What if the Paramedic disagrees with the treatment plan? Too many questions to answer further if this is the scenario but the tool in principal is a good one. I am in Wester Ross and 90 minutes from A&E by road.

This would be good if troponin was diagnostic; it is not and there are false positives; moreover the evidence is that thrombolysis is of greatest value in ST elevation MI, which is an ECG diagnosis. Checking troponinin will increase on- scene time, and probably result in unnecessary risk from inappropriate thrombolysis which can result in death in up to 1/50 victims. Better to drive towards a revascularisation centre than waste time on scene. These are some of the causes of raised troponin Acute aortic dissection Arrhythmia Hypotension Heart failure Apical ballooning syndrome Endocarditis, myocarditis, pericarditis Hypertension Infiltrative disease • Amyloidosis, sarcoidosis, hemochromatosis, scleroderm Left ventricular hypertrophy Myocardial Injury Blunt chest trauma Chemotherapy Hypersensitivity drug reactions Envenomation Respiratory Acute PE ARDS Sepsis/SIRS Viral illness Thrombotic thrombocytopenic purpura Severe GI bleeding Acute stroke • Ischemic stroke • Hemorrhagic stroke Head trauma Renal Chronic kidney disease Endocrine Diabetes Hypothyroidism Musculoskeletal Rhabdomyolysis Integumentary Extensive skin burns Inherited Neurofibromatosis Duchenne muscular dystrophy Klippel-feil syndrome Others Endurance exercise Environmental exposure • Carbon monoxide, hydrogen sulfide