Troponin & Communication

Hey guys,

Currently I am completing my cardiorespiratory placement; with time being spent between the medical and surgical wards. A new patient presented to the medical ward with a query of pneumonia. Therefore it was indicated for physiotherapy to perform a respiratory assessment and a mobility assessment. Both my supervisor and I read the patients notes and proceeded with our assessment as usual. After checking the patient’s chest expansion, cough, auscultating and completing the patients subjective it was time to assess their mobility. The patient was asked to stand and nothing was contraindicated to walking, therefore a short walk on the ward was carried out with continual monitoring taking place. The patient was returned to bed without any events or nothing abnormal.

The patients nurse then came up to us and said that the patient was supposed to be on bed rest as the patients had an elevation in troponin levels. Neither my supervisor or I had seen this in the patient notes. Reading them again it was with great difficulty that there was some writing that resembled the word troponin- 0.15. There was nothing else in the notes that might have indicated the patient be on bed rest as the doctors did not write this in the notes. It is not routine for the physiotherapist to talk to the doctor in what appeared to be a straight forward case. For those who may not know troponin is an enzyme that is released by the heart when there has been a MI or death of some of the cells of the heart.

During the physiotherapy intervention the patient did not report any chest pain, increased WOB, dizziness or nausea. With monitoring by a pulse oximeter the SpO2 and HR stayed within acceptable limits. The key point here was that a lack of communication could have resulted in an adverse outcome for the patient, and it wasn’t just verbal. Written notes were difficult to read. Fortunately the patient was fine and didn’t have any effects from getting out of bed. The bottom line is that if in doubt than consult with the other health professionals. I didn’t feel very good about the situation upon reflection and have tried to analyse what I could have done differently to prevent this happening again.

Thanks