mssmem.com

I forget…what did that email say? oh yeah, its at mssmem.com

Archive for August, 2012

Admission criteria for medical telemetry

The following describes patient groups, which are appropriate for telemetry monitoring on 11-West, 9-West, 10-West. These patients do not require specialty care provided on cardiac units. These criteria are meant as a guide and do not override clinical judgment.

1. A patient with history of CAD who presents with typical or atypical chest pain and does not have high-risk features (Ischemic EKG, low systolic blood pressure, decompensated CHF, history consistent with unstable angina) requiring a cardiac unit.
a. Patients who already have 2 consecutive negative troponins or at least one troponin 6 hours after the onset of chest pain are unlikely to benefit from telemetry

2. Patients with syncope who have high risk features for cardiac cause, including low systolic blood pressure, CHF, CAD, or advanced age(<65). 3. Medication or drug toxicity wit potential arrhythmogenic consequences. a. Examples include monitoring after overdose of a tricyclic antidepressant or digoxin or cocaine toxicity. 4. Electrolyte imbalances. a. Example includes hyperkalemia with ECG changes. 5. Patients with atrial fibrillation/flutter who are hemodynamically stable but are actively being managed for rate control. 6. Tachyarrhythmias requiring continuous intravenous therapy that can be managed by the nursing unit (e.g. IV cardizem). 7. Symptomatic bradyarrythmias. 8. Selected stable patients post procedure from heart hospital at discretion of attending (11 west only, managed by ADS nurse practitioner) 9. Any patient requiring continuous heart rate monitoring that is not otherwise specified above but is deemed medically indicated by the clinician.

Written by phil

August 28th, 2012 at 2:42 pm

Posted in Admitting,Cardiology

Recommended criteria for admission of patients to cardiac telemetry

(last update: February 27, 2008)

o High risk acute coronary syndromes characterized by a clinical history suggestive of ischemia and one or more of the following:
? Electrocardiographic evidence of acute or recent myocardial infarction
• Pathologic Q waves in two or more leads (new or not known to be old)
? Electrocardiographic evidence of acute myocardial ischemia
• ? 1mm ST depression in two or more leads (new or not known to be old)
• T wave inversions in two or more leads (new or not known to be old)
? Positive biomarker for myocardial ischemia (troponin I)
? Systolic BP < 110mm Hg ? Crackles above the lung bases ? Recent coronary intervention or coronary bypass surgery ? Worsening of established anginal pattern in the setting of known ischemic heart disease o High risk congestive heart failure (CHF) characterized by one or more of the following: ? Systolic hypotension ? Ventricular arrhythmias ? Persistent hypoxemia ? Significant hyponatremia (sodium < 130) ? Renal insufficiency (stage IV-V chronic kidney disease or acute renal failure ? stage III) ? Requirement for IV vasodilator or inotrope therapy ? Known or suspected severe aortic or mitral valvular stenosis ? CHF secondary to an acute coronary syndrome o Syncope with high suspicion for a cardiac etiology characterized by one or more of the following: ? History of CHF ? History of ventricular arrhythmia ? Acute coronary syndrome ? Significant aortic or mitral valvular stenosis ? Electrocardiograph with arrhythmia/ prolonged QT/ bundle-branch block or acute ischemia ? History of myocardial infarction ? Prior implantation of pacemaker or ICD ? Second or third degree heart block o Tachyarrhythmias requiring continuous intravenous therapy o Symptomatic bradyarrhythmias o Patients who require urgent invasive cardiac procedures o Patients who require observation immediately following invasive cardiac procedures o Patients receiving chronic infusions of vasoactive medications o Other patients who, in the judgment of the treating attending cardiologist, require specialized cardiac care Depending on the clinical scenario, individual patients meeting the above criteria for admission to cardiac telemetry may be appropriate for admission to the Cardiac Care Unit (CCU) instead.

Written by phil

August 28th, 2012 at 2:40 pm

Posted in Admitting,Cardiology

Interventional Radiology Pager

f you have a case that may need urgent / emergent IR involvement (and would prefer not go through the rads resident to explain your clinical decision making), the in-house pager is RADS (7237).

Luke

Written by phil

August 28th, 2012 at 12:53 pm

Glidescope AVL Featuring *Disposable Blades*

Everything you need to know about the new glidescope:

Tips on using the Glidescope

1. Looking at the mouth, first insert the Glidescope into the midline of the oral cavity, then look at the monitor and advance the Glidescope to view and then elevate the epiglottis, exposing the glottis.

2. Less force is required to expose the glottis using a Glidescope than with conventional laryngoscopy because of its steep angle. The Glidescope can be used to elevate the epiglottis indirectly by placing the tip of the handle into the vallecula (Macintosh technique), or by using the handle tip to directly lift the epiglottis (Miller technique).

3. Once optimal glottic view is obtained on the monitor, look back at the mouth to insert the ETT immediately adjacent to the handle, then, as the tip of the ETT approaches the tip of the Glidescope, look back at the monitor to guide the ETT through the vocal cords.
4. If the ETT does not easily pass into the glottis, use your thumb to push the stylet out of the ETT 2 inches as you advance the ETT through the vocal cords.

5. It may be easier to advance the ETT if the view of the glottis is relaxed, so that you see less of the cords. If using a conventional malleable stylet rather than the Glidescope stylet, bend the stylet to 50-60 degrees at the cuff to match the Glidescope handle.

For more insight on using how using a glidescope requires a different technique compared to direct laryngoscopy, have a read of Levitan’s paper on the subject.

Contact phillip.andrus@mssm.edu with any problems regarding the Glidescope.

Written by reuben

August 7th, 2012 at 7:52 am

Posted in Airway