To improve the diagnostic accuracy of the ED physician for acute coronary syndromes, many evaluation strategies and diagnostic adjuncts to the traditional history, physical examination, and baseline ECG have been developed. The use of diagnostic decision aids (algorithms, predictive instruments, and neural networks) that incorporate and synthesize the information gleaned from the presenting history, physical examination, and the initial ECG will be discussed in more detail in Chapter 8. The use of serial ECGs or continuous 12-lead ECG monitoring for ST-segment shifts, as well as both acute echocardiographic and sestamibi nuclear imaging, offer promise in facilitating diagnosis and triage in the ED setting. However, they remain limited by availability of services and technical expertise in many facilities. Research addressing the diagnostic ability and cost of such strategies will be needed before widespread use can be promoted.
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