Understanding abnormal arterial waveforms is crucial in diagnosing various cardiovascular conditions. These waveforms, visualized through arterial pressure tracings, provide insight into the mechanical performance of the heart and the vascular system. Here are some common abnormal arterial waveforms: Pulsus bisferiens has two distinct systolic peaks (or the second in early…
In this fluoroscopy clip, one appreciates that attempting to remove a Swan-Ganz catheter results in traction near the cavoatrial junction. Ultimately, the Swan had to be removed through a small right atriotomy, revealing that the catheter was trapped by a stitch. It just goes to show that if something isn’t…
Intraabdominal hypertension (IAH) and abdominal compartment syndrome are defined as sustained intraabdominal pressure (IAP) ≥ 12 mmHg and > 20 mmHg with new organ dysfunction, respectively. This can be challenging to diagnose in patients who are pregnant, obese, or with ascites. Bladder pressure from a Foley catheter can be used…
Variable area flowmeters consist of a tapered, vertically-oriented tube with the smallest diameter at the base and largest at the top. As a result, the cross-sectional area of the tube changes based on height. In this example, a ball indicator sits at the base due to the downward force due…
It’s relatively easy to determine the drug name, concentration, volume to be infused (VTBI), and dose/rate for medication on an Alaris® infusion channel. But what does that horizontal bar for each infusion represent?!
As a cardiothoracic anesthesiologist and intensivist, I routinely place large central lines for resuscitation, vasoactive/inotrope administration, and to facilitate additional monitoring (e.g., Swan Ganz catheter). Over the years, I’ve heard “MAC,” “sheath introducer,” “Cordis,” etc., used interchangeably but incorrectly. Let’s break these terms down!
“With Apple Watch Series 6, you can measure your blood oxygen right from your wrist.” This was the punch line for Apple’s latest update to its Watch lineup during the “Time for a recap” event on September 15th. The intensivist and anesthesiologist in me was irked by the constant reference…
Central venous pressure (CVP) or right atrial pressure (RAP) waveform tracings can oftentimes provide useful insight into a patient’s right ventricle (RV), tricuspid valve (TV), and overall cardiopulmonary status. The waveform morphology is easier to identify at slower heart rates and consists of three waves and two descents:
Systemic cardiac output (CO) is the product of left ventricular stroke volume and the heart rate (CO = SV x HR). I see CO measured with thermodilution (Td) and the Fick equation… two techniques which often give very different values.
In the world of perioperative and intensive care medicine, I’m surrounded by continuous monitors; however, it’s important to understand how monitors work (and the pitfalls associated with them) before one interprets the numbers they provide. Since most monitors don’t understand the clinical context, they will alarm incessantly for predefined thresholds.…