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Francisco J Soto, MD, MS, MBA Profile picture
Francisco J Soto, MD, MS, MBA
@FSotoMD
Pulm/CritCare | Pulm Vascular Dz | Fellowship APD | Right🫀Cath Connoisseur |🫀🫁 #Hemodynamics | CritCareEcho | #POCUS | 🇺🇸🇨🇴 | My Opinions
Jan 30 • 12 tweets • 6 min read
1/11

#PAC 101 (The Catheter)

A cath lab pt just arrived in your ICU with a pulmonary artery catheter (#PAC) in place.

Your bedside nurse (limited #PAC experience) asks you to walk her through the basic PAC lumens and ports 😱

Fortunately for you, you had bookmarked the 🧵 👇🏻 Image 2/11 But first!

For those of you exposed to #PAC in your daily job:

How comfortable do you feel with the #PAC connections and setup (honest answers only; no one will know your individual answer)?
Jan 19 • 12 tweets • 5 min read
1/10
Avoiding a PA catheter #PAC nightmare! (bookmark this)

Evening rounds in ICU.
Pt with #PAC in place. “Wedge” 25 mmHg 2d ago. Great diuresis since.

Last 8h urine output is ⬇️
Time for wedge recheck

You fully inflate the #PAC balloon (1.5 cc)
1m later, heme is pouring👇🏻
Image
Image 2/10

Before we go on.

In your opinion, what is the scariest potential #PAC complication
Oct 10, 2022 • 25 tweets • 13 min read
[1] #Hemodynamics Tweetorial #2

Heart failure pt in ICU is -3.5L after 2d of aggressive diuresis. On day 3, urine output is ⬇️and BUN/Cr is ⬆️

You personally wedge #PAC at bedside and obtain a mean wedge 17 mmHg (a normal mean wedge is 6-10 mmHg). Admission wedge was 24 [2]
Question 1. Based on wedge 17 mm Hg (good waveform; no trick), you: