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Jun 19, 2023 14 tweets 5 min read Read on X
Randomised clinical trials in cardiogenic shock in the PCI era Image
Treatment considerations for patients with AMI-cardiogenic shock Image
Enrolment data for major randomised cardiogenic shock trials (EuroIntervention 2021; 17: 451-65) ImageImage
Determination of the Society for Cardiovascular Angiography and Intervention (SCAI) Shock stage using the revised SCAI Shock Classification Image
Conceptual model showing the overlap between
different states of hemodynamic compromise. Shock is defined by presence of hypoperfusion; most, but NOT ALL, patients will also be hypotensive. Pts w hemodynamic instability who do not meet criteria for shock are labeled as pre-shock Image
Management algorithm for patients with or at risk for cardiogenic shock (CS) tailored to the Society for Cardiovascular Angiography and Intervention (SCAI) Shock stage Image
Framework of clinical parameters to follow in patients with heart failure-related cardiogenic shock in the critical care unit Image
Considerations for invasive hemodynamic assessment in HF-CS Image
Classification and management of HF-CS Image
It seems that the most controversial issue is the use of short-term mechanical circulatory support for cardiogenic shock. So, a very recent publication deals with this: Image
Proposed overview of selection of patients to pVAD based on SCAI shock class A-E Image
Flowchart to identify and handle potential need for escalation of mechanical circulatory support in patients supported by axial flow pump (AFP) Image
Flowchart to identify and handle potential need for venting during V-A ECMO support Image

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More from @IM_Crit_

May 3
ICU Upper GI Bleeding (UGIB) Secrets:

Is there anything regarding UGIB that has not been already done, studied or tweeted about? Not much, but all of the following are things I witnessed happening (or not happening…) in two UGIB cases I recently saw in the ICU

Here it begins:
1. If a patient does not have an obvious UGIB as in the clip above, she has just presented with melena & it is still unclear if this is due to upper or lower GIB, a quick & dirty trick is to check the blood urea nitrogen/creatinine (BUN/creat) ratio. There are various published
cut-offs in the literature (don’t sweat about them…) but, in general, a ratio of >30 suggests UGIB. This is due to the small bowel absorption/digestion of blood protein which is subsequently metabolized to urea. There are confounding factors, but the trick usually works well
Read 21 tweets
Apr 28
The patient whose ECG/POCUS clips I posted yesterday has remained hemodynamically stable & neurologically intact

This was the #ECG today; still looking angry: Image
I repeated #POCUS; no significant changes:
If you a #VEXUS friend, these are bonus images; no venous congestion:

PS: @MynephCC @NephroP will kill me for not having ECG tracing but we don't have an ECG cable in the trenches... 🤷‍♂️ Image
Image
Image
Read 5 tweets
Apr 27
ICU Stories:

Walking from room to room in the ICU on a Sunday morning while hoping to have a quiet shift, you notice this 👇 on a patient's monitor (60 yo, admitted, intubated for COPD exacerbation + pneumonia 3 days ago, now sedated/hemodynamically stable) Image
It's unfortunately hard to pretend you didn't see it, so you get an ECG praying that it will not show what you saw on the monitor... 😊

Of note, admission ECG was "ok"

Well, it actually looks more impressive on the 12-lead ECG: Image
Now, what are you concerned about?
Read 11 tweets
Apr 26
ICU Line Secrets:

Is there anything about "lines" that has not been done or studied already? Not much, I guess, so these actually are not secrets, just things I had to do the last couple of weeks & hopefully you also find useful in your practice

Here it begins:

1. "Twin lines" Image
in the same vessel, if there is anatomical reason/venous thrombosis etc that limits the available options. I have even placed a 3rd line (Swan sheath) in the RIJ at the same time but the more of venous real estate is occupied by catheter lumens,
the higher the risk of venous thrombosis

Regarding the technical part of the procedure: I find it easier to place all the wires first & then railroad the catheters over them. This decreases the risk of puncturing the first catheter when trying to locate the vein for the second
Read 22 tweets
Apr 10
Refresher on Swan-Ganz catheter: Image
Comparison of pulmonary artery catheterisation with different cardiac output monitoring devices: Image
Anatomy and description of a pulmonary artery catheter: Image
Read 10 tweets
Apr 6
ICU Hemodynamics:

If you are managing patients with #vasoplegicshock, this is a nice review article: Image
Vasoplegic shock (VS) is common, contributing up to two-thirds of cases of shock admitted to the ICU

The two most common VS causes: septic shock & vasoplegic shock after cardiopulmonary bypass

There is NO consensus definition of vasoplegic shock
If you like the pathophysiology "stuff": Image
Image
Read 7 tweets

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