Issue

St. Joseph Mercy Oakland

admin — Fri, 26 Jun 2009 10:42:46 -0400

St. Joseph Mercy Oakland (SJMO) is a 443-bed, Pontiac, Michigan-based, comprehensive, community and teaching hospital that continues to receive awards of excellence in medicine. Our clinical and high-quality outcomes rank among the top 10 percent of hospitals nationwide. The SJMO Heart Institute was recognized by Thomson Reuters as a national Top 100 Heart Hospital, and SJMO was named a Blue Cross/Blue Shield of Michigan and Blue Care Network Cardiac Center of Excellence.

Tell us about your cath lab and staff.

Nurse Management With 1-Hour Ambulation Post 4 French Cardiac Catheterization is Safe and Cost Effective

admin — Fri, 26 Jun 2009 11:20:51 -0400

Abstract

Background. Catheterization laboratory cardiologists and nurses are downsizing diagnostic catheters to enable earlier patient ambulation without compromising safety. Aims. The team sought to determine the safety and cost effectiveness of ambulation 1 hour after manual compression using 4 Fr diagnostic femoral catheters. This would enable a drastic reduction in bedrest time from our current practice. Methods. A total of 768 consecutive patients were ambulated 1 hour after a mean manual compression time of 9 minutes.

Percutaneous Mitral Valve Repair

admin — Fri, 26 Jun 2009 11:29:52 -0400

What is mitral regurgitation?

Impella® 2.5 Support During PTCA of Patient with Extreme Tortuosity of the Ileofemoral System

admin — Fri, 26 Jun 2009 12:13:24 -0400

Introduction

We present a 63-year-old male with chronic angina, ischemic cardiomyopathy with an ejection fraction of 20%. He had coronary artery bypass grafts placed in 1990 and has a bi-ventricular implantable cardiac defibrillator (ICD). He presented with chest pain and a mild troponin elevation. A cardiac catheterization was performed, which revealed a 95% left main calcified stenosis with an occluded left anterior descending artery (LAD) and a patent but distally diseased left interior mammary artery (LIMA). He also had an occluded circumflex vessel, a ramus with a diffuse 80% stenosis, and an occluded right coronary artery (RCA). A saphenous vein graft (SVG) to the ramus/first obtuse marginal branch (OM1) was occluded but the segment of graft from the ramus to the OM1 was patent. Hemodynamics revealed elevated pulmonary capillary wedge pressure (PCWP).

Ask the Expert: The Wholey Wire

admin — Fri, 26 Jun 2009 12:24:50 -0400

Can you tell us about your practice and work as founder and medical director of the Baptist Cardiac & Vascular Institute?

Ask the Clinical Instructor: Questions are answered by Todd Ginapp, EMT-P, RCIS, FSICP

admin — Fri, 26 Jun 2009 12:28:14 -0400

When I look at the aortic pressure on the monitor during a case, I notice the little line running across the middle. They tell me that is a mean arterial pressure. Why do I need to know that?

— Virginia CVT student

The mean arterial pressure (MAP) is an important tool to have available for monitoring of a patient over time. It is usually already calculated on your hemodynamic monitoring screen, but maybe you didn’t have an idea of what it was.

The MAP is simply the average blood pressure of an individual. It’s defined as the average arterial pressure during a cardiac cycle. Our monitoring systems continuously monitor this number.

To figure out a MAP, it is a simple calculation:

For example, if your patient’s blood pressure is 120/80, the MAP would be:

Medical Simulation and Testing Developments

admin — Fri, 26 Jun 2009 14:25:04 -0400

Radial Artery Catheterization: The way to go

admin — Fri, 26 Jun 2009 14:28:47 -0400

Last month, I visited Dr. Olivier Bertrand at Laval Hospital in Quebec City, Canada, to present a talk on coronary physiology. He and his team showed me their lab and method of performing radial artery catheterization for their 10,000 patients of 2008-2009, with 3,500 percutaneous coronary interventions (PCIs) from the same approach. They reported no retroperitoneal hematomas, femoral pseudo aneurysms, fistula or femoral artery bleeds, occlusions or emboli. The complications from radial artery access are trivial compared to femoral, with <4% loss of radial artery pulse as the worst of it. I was forced to reconsider my old ways. Why do I persist with femoral artery access when complications from radial access are so much lower? If I said, hypothetically, that the left femoral approach had 10 times the complications as the right, I would never go to the left. If I now say the femoral artery has 10 times the complications compared to the radial approach, why would I ever use the femoral?

SICP: Chapter Spotlight

admin — Fri, 26 Jun 2009 14:32:47 -0400

SICP Advocacy Survey

The SICP Advocacy Committee created a short survey to bring awareness to advocacy issues taking place in facilities across the country.

Please go to www.sicp.com to take the survey.

If any of the issues addressed in the survey have occurred to you or someone you know, please contact the SICP at director@sicp.com.

What Do You Think?

admin — Fri, 26 Jun 2009 14:35:59 -0400