Non-ionic, low osmolality: Omnique (2-3x plasma osmolality)
Some images worth learning from are posted here (Note: Most of them are plagiarised. But, sources are referenced)
5/29/2010
Cath: Ballon pulmonary angioplasty
Indications for intervention:
1) At least 50% stenosis by diameter
2) Lung perfusion scan showing more than 20% discrepancy between the two sides (Don't forget regional differences within the same lung)
3) RVSP >50% (or 70% by others)
4) Significant pulmonary regurgitation with moderate distal PA stenosis (Asso. RV enlargement)
Arbitrary definition of successful Balloon PA angioplasty:
1) More than 50% increase in diameter
2) 20% drop in RVSP
5/23/2010
Anatomy: Terminology: Van Praagh's segmental formula
Original description: Van Praagh R. The segmental approach to diagnosis in congenital heart disease. Birth Defects;1972:8:4.
5/20/2010
Echo: Mitral Inflow Doppler
(Extract from JASE 2010;23:465-495)
1. Normal MV inflow Doppler:
2. Isovolumic Relaxation Time
(Duration between closure of AoV and Opening of MV)
Measured from CW Doppler trace that has both LVOT and MV flows.
3. Deceleration time
Deceleration time for E wave.
Echo: Normal Pulmonary (&Systemic) Vein Doppler pattern
Normal Doppler Pattern in Pulmonary (& Systemic) Vein:
(Extract from JASE 2010;23:465-95; Pulmonary Vein PW Doppler)
Provides evaluation of Ventricular Diastolic Function and AV valve Function.
(Extract from JASE 2010;23:465-95; Pulmonary Vein PW Doppler)
Provides evaluation of Ventricular Diastolic Function and AV valve Function.
S wave: (Antergrade flow during Ventricular Systole)
Antegrade flow occurs because of both Atrial relaxation and Apical movement of AVV;
Biphasic if there is temporal dissociation of atrial relaxation and apical movement of AVV.
Abnormal retrograde flow occurs with AVV regurgitation & Atrial contraction against closed AVV.
D wave: (Antegrade flow during Ventricular Diastole)
Antegrade flow occurs because of Atrial and Ventricular filling & AVV patency.
Fast HR - leads to fusion of S and D peaks.
Ar wave: (Retrograde flow during Atrial systole)
Augmented when ventricular compliance is poor.
Ar wave duration exceeds MV inflow duration when LAP & LVEDP are elevated.
Respiratory variation:
During inspiration - D wave velocity increases. Ar wave velocity decreases.
So, measurements should be made over 3 consecutive cycles.
5/14/2010
Atul Gawande: Professionalism
From "The Checklist Manifesto"
All learned occupations have a definition of professionalism, a code of conduct...But, they all have at least 3 common elements...
First, is an expectation of selflessness.
Second, is an expectation of skill.
Third, is an expectation of trustworthiness.
Aviators, however, add a fourth expectation, discipline; disciplinein following prudent procedure and in functioning with others...
In medicine, we hold up "autonomy" as a professional lodestar, a principle that stands in direct opposition to discipline...it rings more of protectionism than of excellence. The closest our profession comes to...is an occasional plea for "collegiality".
Discipline is hard, harder than trustworthiness and skill and perhaps even than selflessness. We are built on novelty and excitement,...Discipline is something we have to work at.
5/12/2010
Cath - "Sleeping Bat View" to image distal end of Sano Shunt & Proximal branch PAs
ICU strip
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