ROACS March 2018 | by EMauthor ROACS means Rule Out Acute Coronary Syndrome. Acute coronary syndromes consist of NSTEMI, STEMI and unstable angina (the latter can only be ruled out clinically). In the ED, many patients presenting with chest pain are discharged. Hypothetically, if an unfortunate event or incident warranted re-examination of these case notes, our documentation would usually need to contain the following in order to be medicolegally defensible: EITHER •Symptoms evidentially a non-cardiac cause and treated appropriately. OR all of the following •Two negative troponin samples spaced at least 2 hours apart, the second sample being 6 hours after the cessation of symptoms. oFor example if the pain stopped around 15:00 and the admission troponin taken at 19:00 is normal, a repeat sample taken at 21:00 would also have to be negative. oIf 12 hours has elapsed since symptoms, one troponin will usually be sufficient. •At least 2 ‘normal’ ECGs. •Symptoms not suggestive of unstable angina. •HEART score 3 or less [See the diagram below]
Medical Ambulatory Emergency Care Unit The Medical Ambulatory Emergency Care Unit based on AMU East can assist with ROACS patients to take the second troponin sample provided the other ROACS parameters have been met. These is currently the provision of the expansion if the AECC to include monitored beds thus they may be able to accept higher risk patients at the discretion of the senior doctors. If AECC is closed or full to capacity, ROACS patients can be moved to CDU for the repeat troponin. |
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