The Journal of family practice
-
Elevations of serum troponin T and I values are being used to diagnose acute myocardial infarction (AMI) and to rule out the condition in patients before their discharge from the emergency department (ED). However, the sensitivity and specificity of these tests vary considerably. Our goal was to systematically review the data on the accuracy of troponin T and I for the diagnosis of AMI in the ED. ⋯ Although troponin T and I values are useful tools for the diagnosis of AMI, they must be interpreted according to the number of hours from the onset of chest pain. The test is particularly useful at ruling out MI when the value is negative at 8 or more hours after the onset of chest pain.
-
Comparative Study
Intrathecal narcotics are associated with prolonged second-stage labor and increased oxytocin use.
Safe and effective labor analgesia is an important part of obstetric care. Intrathecally injected narcotics (ITN) are an effective alternative to epidural anesthesia, and are perceived less likely to interfere with the course and outcome of labor. Data on their effects, however, are sparse and contradictory. ⋯ In our retrospective study, ITN use was associated with a significant prolongation of second-stage labor, which may be clinically relevant for women having their first child. ITN were also associated with increased oxytocin use and a trend toward more cesarean births. Whether these relationships are causal or a proxy for more difficult labors is a question for future prospective studies.