Friday, September 21, 2018

New Lecture on High Sensitivity Troponin Protocols in the ED

It is my task to educate our residents on chest pain, ECGs, and troponin.  So for years I have been lecturing on the topic of chest pain and troponin.

I put the last one online in 2015, and has had 25,000 views.  It is embedded at the bottom of this post, and is called:

Approach to Potential Ischemic Chest Pain in the Emergency Department

The first 25 minutes are all about the data on worrisome characteristics of chest pain.  Most of the rest would now be slightly out of date.

Below is the new one: 
High Sensitivity Troponin; Considerations for Implementing ED protocols.

There is a huge amount of new data since 2015, and it will keep accumulating.

I have tried to distill a huge literature down to fewer important studies, and I give my bottom line summary, but there is still a huge amount of data.  This is my reading of the literature.  It is not peer-reviewed.  I'm sure there are many who would disagree with my summary slides.  But I present a lot of data so that you can make your own decision.  A file of the outline of the slides can be accessed on my Google Drive via the link.

The purpose of this lecture is to expose you to the broad spectrum of high sensitivity based protocols that your ED might choose from.  You will not be able to use it on your next patient, but use it to institute a protocol that works for your institution.  So just sit back and listen.

One thing I forgot to address in the lecture: Acute Occlusion Myocardial infarction (OMI).  There is no evidence that hs troponin will help in the early diagnosis of acute coronary occlusion vs. non-occlusive MI.  It does help in early diagnosis of MI (of OMI/NOMI), but does not differentiate.

Thanks to Scott Joing for recording this.  Scott is our tech wizard and fine emergency physician, and co-editor of Ma and Mateer's standard EM ultrasound textbook.  He is the creator of

Also thanks to my incredibly bright and knowledgeable troponin research partners, both of whom know much more about troponin than I do.  They are Fred Apple and Yader Sandoval 
(, and also to the Cardiac Biomarkers Research Lab, especially Karen Schulz, at Hennepin and Minneapolis Medical Research Foundation.

High Sensitivity Troponin; Considerations for Implementing ED protocols.

The text of the slides can be seen here in .rtf format:

The text of the slides can be seen here in .rtf format:

This is the previous lecture from 2015.  

The first 25 minutes have a lot of good stuff on chest pain. The high sensitivity info which comes later is somewhat out of date.


  1. I learn so much from your website. Thank you!

    1. Dr. smith, Sent you an email about possibly lecturing in Florida. Any interest?

    2. Dustin,
      I did not get the email.
      Please try again at:

  2. Dear doctor Steve
    You are a great person by publishing your own experiences in this amazing website.
    Keep going


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