24 February 2021 - Cardiovascular I

Program

1000-1130 - Morbidity & Mortality Meeting - Kirsten Cassidy

1130-1155 - Pacing - Matt Bray

1155-1203 - ECG of the Week - Sarah Bannerman

1203-1210 - Image of the Week - Ben Lee

1210-1230 - How to Give a Talk - Alex Handrinos

1230-1300 - Lunch

1300-1445 - Small group practical sessions (45min each)

• Cardiac simulation

• Pacing and Defibrillation

• POCUS Echo

• ABGs

Separate program for OSCE candidates as arranged with Brendan Morrissey.

How to float a pacing wire:

How to use the pacing function on our ED defib machines:

Key Learning Points

Thanks to Gem Ridley for this week’s Teaching Pearls:

Morbidity & Mortality Meeting

• If you have clinical suspicion of a Lisfranc fracture, ensure you emphasise this to Radiology when requesting a CT

• Be aware of the speed of bikes on triage notes. At the record-winning event, Usain Bolt's average ground speed was 37.58km/h = Cyclists are therefore always travelling slower than Usain at 20km/h.

Ben Lee’s Neuro Exam

• Extend wrist - Radial

• Abduct fingers - Ulnar

• Circle of “OK” - Median

Bradycardia 

• Causes — “Don’t let your patient DIE”

Drugs — beta blocker, calcium channel blocker, cholinergic, digoxin

Ischaemia — acute myocardial infarction / ischaemic cardiomyopathy 

Electrolytes — BRASH for bradycardia, renal failure, AV node, shock, hyperkalaemia 

• Transcutaneous pacing — ensure you have your 3-lead attached to the defib as well as the pads!

• Australian Resuscitation Council’s guidelines to managing acute dysrhythmias here

ECG of the Week

An asymptomatic 84 year old man is referred by his GP to ED for review of an incidental finding of bradycardia.

List three abnormalities.

●     Bradycardia - 36 (30 - 50)

●     Irregular 

●     No p waves   

●     Left axis deviation

This is slow AF, i.e. AF with a slow ventricular response. Important normalities to note are a narrow QRS and no T wave inversion.

List causes of this presentation.

• Medications - beta blockers*, digoxin*, calcium channel blockers, amiodarone, clonidine, organophosphate toxicity

• Cardiac (heart blocks including complete) - ischaemia, myocarditis, cardiomyopathy, congenital, sick sinus syndrome*

• Hypoxia

• Electrolyte abnormalities (high K and low Mg)

• Hypothermia (< 35 °C)

• Raised ICP (Cushing’s triad)

• Hypothyroidism

• Autoimmune

• Sarcoidosis/Amyloidosis

• Physiological (extreme fitness, vagal tone)

*Class IIb evidence in asymptomatic patients

What (definitive) management should be considered?

• Withhold medications

• Address reversible causes (e.g. high K or low Mg, hypothyroidism, etc)

• PPM (Class IIb evidence in asymptomatic patients)

Image of the Week

29 year old lady presents having been assaulted with a fall to the floor and head strike.

Name 4 pertinent traumatic finding on this CT brain image.

• Large occipital swelling

• Occipital fracture

• 10mm acute subdural haematoma

• Contrecoup injury to right frontal lobe
  

ADDIT: Hey guys, apologies for the quality of the CTB slice. It was taken off a phone so some of the abnormalities are difficult to see. (It’s not you, it’s the image!)

Name 2 pertinent negatives of this CT scan which you may report to the Neurosurgical Registrar.

• No local mass effect/effacement of ventricles

• No midline shift

Name 3 spaces/ventricles of the brain that can be seen on this image.

• Frontal horn of lateral ventricles

• Third ventricle

• Choroid plexus