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OP Kapoor

Ex. Hon. Physician, Jaslok Hospital and Bombay Hospital, Mumbai, Ex. Hon. Prof. of Medicine, Grant Medical College and JJ Hospital, Mumbai 400 008.

Today, even a person like me has a fear that the day I get an attack of myocardial infarction (easily diagnosable by presence of risk factors and chest discomfort with sweating), the question is whether I will get a bed in any ICCU in my locality.

The fact is that the ICCU units are over loaded often with wrong type of patients. There are other nursing homes which claim to have ICCUs but there are no facilities available of an intensivist.

In modern days, it has been shown that without the services of day and night intensivist, the results of morbidity and mortality do not warrant to send a patient to an ICCU. Thus all the private hospitals and authorities owning ICCUs must employ qualified day and night intensivist in their ICUs. Also a dedicated staff is a must. Thus these should be known as "Intensified" ICU centres.

I must remind the family physicians that the ICCU is not meant for only treating patients having myocardial infarction. More often it is used to "exclude" patients of unstable angina and myocardial infarction.

The question is what can family physicians do to prevent over loading of these ICUs. Start doing troponin levels (I and T) and send blood to the pathological laboratory for an urgent report in patients complaining of chest pain.

If the patient complains of chest pain at night and the blood troponin levels are normal, but the patientís condition is not bad and neither is he affording type or keen to go to the hospital, then the troponin levels should be repeated in the morning (after eight hours). If by that time the troponin levels are normal again, the patient should not be sent to an ICU, specially if the clinical picture does not fit into a diagnosis of typical unstable angina or myocardial infarction.

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