DOCSLIB.ORG

Cardiopulmonary Resuscitation and Advanced Cardiac Life Support: Common Errors and Current Techniques

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Cardiopulmonary Resuscitation and Advanced Cardiac Life Support: Common Errors and Current Techniques Cardiopulmonary Resuscitation and Advanced Cardiac Life Support: Common Errors and Current Techniques Stuart Frank, MD Springfield, Illinois Competence in the techniques of Advanced Cardiac Life Sup­ port is essential for physicians who are in frequent contact with patients at high risk for cardiac arrest. The methods utilized are complex and rapidly changing. However, a consis­ tent pattern of errors in fundamental concepts or methods emerges. These can be characterized as (1) errors in the gen­ eral management of patients, (2) errors in basic cardiopulmo­ nary resuscitation (CPR) techniques, (3) mistakes in the use or omission of appropriate drugs, (4) errors in the associated nec­ essary techniques which require some technical skills, and (5) errors in management of the patient subsequent to the cardiac arrest. Attention to these details may increase success in man­ agement of patients with cardiac arrest. An extensive and extremely well-developed life support is excellent but is frequently informal training program in cardiopulmonary resuscitation and unstructured, often neglected, and highly var­ (CPR) for the public has been very well received. iable. There are very few physicians who have The program is effective in teaching fundamental been adequately trained in the complexities of ad­ resuscitation techniques to large numbers of vanced cardiac life support, and fewer still who paramedical or non-medically trained individu­ retain this competence without regular exposure als.1-2 The skills, once mastered, need regular re­ to patients in need of advanced life support. Com­ view to maintain a satisfactory level of compe­ petence requires mastering the subtle aspects tence. This training is directed primarily toward of (a) complex electrocardiography, (b) cardiac out-of-hospital cardiac arrest and resuscitation. It pharmacology, (c) team management, (d) technical follows a simple standard decision tree (Figure 1) procedures including the insertion of venous cut- and ends when the patient enters into a system of downs, pulmonary artery balloon catheters, and advanced cardiac life support (ACLS), the hospi­ temporary pacemakers, and (e) electrical cardio­ tal emergency room, or the intensive care unit. version and defibrillation. In marked contradistinction to the basic cardio­ Despite the wide variation in training and expe­ pulmonary resuscitation, the training of physicians rience of physicians and nurses, it is apparent that and nurses regularly involved in advanced cardiac the same errors, the same misconceptions, and the same inadequacies occur during advanced cardiac life support with surprising regularity at all levels of training and experience. During the observation From the Division of Cardiology, Department of Medicine, of over 500 in-hospital resuscitation efforts, the Southern Illinois University, School of Medicine, Spring- field, Illinois. Requests for reprints should be addressed to most common mistakes and the inadequacies Dr. Stuart Frank, Division of Cardiology, Department of which are most flagrant or potentially most serious Medicine, PO Box 3926, Southern Illinois University, School of Medicine, Springfield, (L 62708. were identified. This paper outlines currently rec- 0094-3509/81 /020213-05$01.25 ® 1981 Appleton-Century-Crofts THE JOURNAL OF FAMILY PRACTICE, VOL. 12 NO. 2: 213-217, 1981 213 CARDIOPULMONARY RESUSCITATION Figure 1. Life support decision tree and entry into system of advanced life support (ALS). (Reprinted with permission American Heart Association) ommended principles for management of cardiac anyone competent if he is there first or when no arrest; these principles are derived from common one else has assumed control. errors of omission or commission. Someone must review the patient’s history or consult with the patient’s family relatively early and continue communications as frequently as General Management possible. This should ideally, but not necessarily, Someone must take charge, to assign, coordi­ be the patient’s personal physician. Sometimes the nate, and oversee; to avoid omissions and dupli­ decision not to resuscitate is obvious, but often it cation of effort; and to ensure that everything is is not, and occasionally aggressive efforts are done in a reasonably coordinated and proper se­ mandated despite apparent contraindications.3 quence. This will often, but not necessarily, be the Clear the room of unnecessary furniture, addi­ patient’s personal physician but he may not be tional patients, and curious spectators. A success­ early on the scene and the coordinator should be ful resuscitation often demands quick action, and the senior or most experienced individual present. rapid access to complex bulky equipment. Work­ The responsibility can and should be assumed by ing with curtains drawn around a bed to ensure 214 THE JOURNAL OF FAMILY PRACTICE, VOL. 12, NO. 2, 1981 CARDIOPULMONARY RESUSCITATION privacy is futile. It is often easier to move other Do not massage the mattress. If the crash cart beds and patients out. does not have a bed board, almost anything flat Someone must decide when to discontinue rea­ and rigid will do. Cardiac massage without rigid sonable resuscitation efforts. This decision should support under the patient delivers most of the en­ be made in consultation with the patient’s personal ergy to the mattress and springs. Moving the pa­ physician and with the patient’s family if they are tient carefully onto the floor is an alternative but is immediately available. Currently accepted guide­ rarely necessary and makes it difficult to perform lines state, “The decision to terminate advanced some procedures such as intubation. cardiac life support based on the findings of cardi­ The hands and body must be in the proper posi­ ovascular unresponsiveness is equivalent to defin­ tion. Fracture of the xiphoid, and hepatic lacera­ ing that the heart has died, and there is no purpose tion may result if massage is too low on the ster­ to be served in evaluating the status of the brain.”2 num, but more important is the resulting ineffi­ The use of large doses of barbiturates to minimize cient massage with incomplete compression of the central nervous system damage and cerebral ventricles. Do not press the fingers into the ribs or edema is still experimental and is not routinely costochondral junctions during cardiac massage. recommended at this time.4 The fingers should be hyperextended with the pressure delivered with the heel of both hands. The resuscitater should be properly positioned CPR Techniques with his shoulders directly over the sternum, his Do not forget to hyperextend the neck (Figure elbows straight, and his knees at the level of the 2). Resuscitation of a patient with his head com­ mid chest. Proper cardiac massage is difficult to fortably on a pillow is doomed to failure. The perform optimally standing next to the bed, al­ tongue drops back to occlude the airway and ade­ though it is sometimes necessary. The ideal posi­ quate oxygenation is impossible. tion may sometimes require getting one’s knees Do not forget the precordial thump.2,5 A wet and dirty. Improper position promotes early sharp vigorous blow to the chest delivers about 5 and excessive fatigue and vastly diminishes effi­ or 10 watt seconds of energy which may be enough ciency. to convert ventricular tachycardia or ventricular The cardiac massage must be smooth and fibrillation to sinus rhythm. Current recommenda­ rhythmic with a goal of 50:50 downstroke: up­ tions indicate that the precordial thump should be stroke ratio.2,6,7 Avoid short unsustained “jabs” used for “monitored arrest” only, since it has which may eject small spurts of blood, and may been shown to produce ventricular fibrillation or generate a peripheral pulse but results in minimal asystole on rare occasions. blood flow. Some experts feel that these spas- THE JOURNAL OF FAMILY PRACTICE, VOL. 12, NO. 2, 1981 215 CARDIOPULMONARY RESUSCITA DON modic motions may be of value in breaking up advanced cardiac life support may require some massive pulmonary emboli, but for the average re­ revision of the technique in the future. Experimen­ suscitation, this is not necessary, it is of doubtful tal studies have shown that cardiac output is max­ value, and the cardiac output generated is in­ imal when the lungs are hyperinflated. Increased adequate. flow is probably related to increased intrathoracic Incomplete sternal relaxation impairs ventricu­ pressure and theoretically, a high airway pressure lar filling and inadequate sternal depression de­ coincident with each chest compression may be creases cardiac output. In an adult the sternum optimal. It should be emphasized, however, that must be depressed at least IV2 to 2 inches toward no changes in traditional techniques are recom­ the spine. mended at this time until the safety of these exper­ Do not interrupt the resuscitation. Standard imental methods has been demonstrated. teaching emphasizes that chest compression and respiration should not and need not be discontin­ Drug Treatment ued for more than 5 seconds except for intubation One cannot resuscitate an hypoxic heart. Ade­ or moving patients, when up to 30 seconds inter­ quate oxygenation is essential. ruption is permitted. Practical considerations One cannot resuscitate an acidotic heart.8 sometimes mandate otherwise. Administration of bicarbonate and frequent eval­ A. It is often necessary to stop cardiac massage uation of arterial blood gases is necessary. for a brief interval to eliminate artifact in the Although
Load more

Recommended publications
  • Left Ventricular Wall Findings in Non-Electrocardiography-Gated CE-CT After ECPR Might Be Useful for Diagnosis and Prognostic Prediction
    Sugiyama et al. Critical Care (2019) 23:357 https://doi.org/10.1186/s13054-019-2624-1 RESEARCH Open Access Left ventricular wall findings in non- electrocardiography-gated contrast- enhanced computed tomography after extracorporeal cardiopulmonary resuscitation Kazuhiro Sugiyama1* , Masamichi Takahashi2, Kazuki Miyazaki1, Takuto Ishida1, Mioko Kobayashi1 and Yuichi Hamabe1 Abstract Background: Few studies have reported left ventricular wall findings in contrast-enhanced computed tomography (CE-CT) after extracorporeal cardiopulmonary resuscitation (ECPR). This study examined left ventricular wall CE-CT findings after ECPR and evaluated the association between these findings and the results of coronary angiography and prognosis. Methods: We evaluated out-of-hospital cardiac arrest patients who were treated with ECPR and subsequently underwent both non-electrocardiography-gated CE-CT and coronary angiography at our center between January 2011 and April 2018. Left ventricular wall CE-CT findings were classified as follows: (1) homogeneously enhanced (HE; the left ventricular wall was homogeneously enhanced), (2) segmental defect (SD; the left ventricular wall was not segmentally enhanced according to the coronary artery territory), (3) total defect (TD; the entire left ventricular wall was not enhanced), and (4) others. Successful weaning from extracorporeal membrane oxygenation, survival to hospital discharge, and predictive ability of significant stenosis on coronary angiography were compared among patients with HE, SD, and TD patterns. Results: A total of 74 patients (median age, 59 years) were eligible, 50 (68%) of whom had initial shockable rhythm. Twenty-three (31%) patients survived to hospital discharge. HE, SD, TD, and other patterns were observed in 19, 33, 11, and 11 patients, respectively. The rates of successful weaning from extracorporeal membrane oxygenation (84% vs.
    [Show full text]
  • Sparse-Input Detection Algorithm with Applications in Electrocardiography and Ballistocardiography
    Sparse-input Detection Algorithm with Applications in Electrocardiography and Ballistocardiography ;1 ;1 2 1 1 F. Wadehn∗ , L. Bruderer∗ , D. Waltisberg , T. Keresztfalvi and H.-A. Loeliger 1 Signal and Information Processing Laboratory, ETH Zurich, Gloriastrasse 35, Zurich, Switzerland 2 Institut fuer Elektronik, ETH Zurich, Gloriastrasse 35, Zurich, Switzerland Keywords: Ballistocardiography, Heart Rate Estimation, Hypothesis Test, Factor Graphs, System identification, State- space Models, Maximum likelihood, Maximum a posteriori. Abstract: Sparse-input learning, especially of inputs with some form of periodicity, is of major importance in bio- signal processing, including electrocardiography and ballistocardiography. Ballistocardiography (BCG), the measurement of forces on the body, exerted by heart contraction and subsequent blood ejection, allows non- invasive and non-obstructive monitoring of several key biomarkers such as the respiration rate, the heart rate and the cardiac output. In the following we present an efficient online multi-channel algorithm for estimating single heart beat positions and their approximate strength using a statistical hypothesis test. The algorithm was validated with 10 minutes long ballistocardiographic recordings of 12 healthy subjects, comparing it to synchronized surface ECG measurements. The achieved mean error rate for the heart beat detection excluding movement artifacts was 4:7%. 1 INTRODUCTION Early signal-processing methods for BCG signals (Watanabe et al., 2005; Mack et al., 2009) concerned Cardiovascular diseases are among the leading causes estimation of heart rates averaged over a few sec- of death and severe health impairments both in high- onds using frequency-based methods. These meth- income countries with an aging population, as well ods do not provide beat-to-beat resolution or infor- as in developing countries, which are increasingly mation on irregular arrhythmias.
    [Show full text]
  • 2Nd Quarter 2001 Medicare Part a Bulletin
    In This Issue... From the Intermediary Medical Director Medical Review Progressive Corrective Action ......................................................................... 3 General Information Medical Review Process Revision to Medical Record Requests ................................................ 5 General Coverage New CLIA Waived Tests ............................................................................................................. 8 Outpatient Hospital Services Correction to the Outpatient Services Fee Schedule ................................................................. 9 Skilled Nursing Facility Services Fee Schedule and Consolidated Billing for Skilled Nursing Facility (SNF) Services ............. 12 Fraud and Abuse Justice Recovers Record $1.5 Billion in Fraud Payments - Highest Ever for One Year Period ........................................................................................... 20 Bulletin Medical Policies Use of the American Medical Association’s (AMA’s) Current Procedural Terminology (CPT) Codes on Contractors’ Web Sites ................................................................................. 21 Outpatient Prospective Payment System January 2001 Update: Coding Information for Hospital Outpatient Prospective Payment System (OPPS) ......................................................................................................................... 93 he Medicare A Bulletin Providers Will Be Asked to Register Tshould be shared with all to Receive Medicare Bulletins and health care
    [Show full text]
  • Electrocardiography: a Technologist's Guide to Interpretation
    CONTINUING EDUCATION Electrocardiography: A Technologist’s Guide to Interpretation Colin Tso, MBBS, PhD, FRACP, FCSANZ1,2, Geoffrey M. Currie, BPharm, MMedRadSc(NucMed), MAppMngt(Hlth), MBA, PhD, CNMT1,3, David Gilmore, ABD, CNMT, RT(R)(N)3,4, and Hosen Kiat, MBBS, FRACP, FACP, FACC, FCCP, FCSANZ, FASNC, DDU1,2,3,5 1Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia; 2Cardiac Health Institute, Sydney, New South Wales, Australia; 3Faculty of Science, Charles Sturt University, Wagga Wagga, New South Wales, Australia; 4Faculty of Medical Imaging, Regis College, Boston, Massachusetts; and 5Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia CE credit: For CE credit, you can access the test for this article, as well as additional JNMT CE tests, online at https://www.snmmilearningcenter.org. Complete the test online no later than December 2018. Your online test will be scored immediately. You may make 3 attempts to pass the test and must answer 80% of the questions correctly to receive 1.0 CEH (Continuing Education Hour) credit. SNMMI members will have their CEH credit added to their VOICE transcript automatically; nonmembers will be able to print out a CE certificate upon successfully completing the test. The online test is free to SNMMI members; nonmembers must pay $15.00 by credit card when logging onto the website to take the test. foundation for understanding the science of electrocardiog- The nuclear medicine technologist works with electrocardio- raphy and its interpretation. graphy when performing cardiac stress testing and gated cardiac imaging and when monitoring critical patients.
    [Show full text]
  • Early Or Delayed Cardioversion in Recent-Onset Atrial Fibrillation
    The new england journal of medicine Original Article Early or Delayed Cardioversion in Recent-Onset Atrial Fibrillation N.A.H.A. Pluymaekers, E.A.M.P. Dudink, J.G.L.M. Luermans, J.G. Meeder, T. Lenderink, J. Widdershoven, J.J.J. Bucx, M. Rienstra, O. Kamp, J.M. Van Opstal, M. Alings, A. Oomen, C.J. Kirchhof, V.F. Van Dijk, H. Ramanna, A. Liem, L.R. Dekker, B.A.B. Essers, J.G.P. Tijssen, I.C. Van Gelder, and H.J.G.M. Crijns, for the RACE 7 ACWAS Investigators*​​ ABSTRACT BACKGROUND Patients with recent-onset atrial fibrillation commonly undergo immediate restora- The authors’ full names, academic degrees, tion of sinus rhythm by pharmacologic or electrical cardioversion. However, whether and affiliations are listed in the Appen- dix. Address reprint requests to Dr. Crijns immediate restoration of sinus rhythm is necessary is not known, since atrial fibril- at the Department of Cardiology, Maas- lation often terminates spontaneously. tricht University Medical Center, P. Debye- laan 25, 6229 HX Maastricht, the Nether- METHODS lands, or at hjgm . crijns@ mumc . nl. In a multicenter, randomized, open-label, noninferiority trial, we randomly assigned *A complete list of investigators in the patients with hemodynamically stable, recent-onset (<36 hours), symptomatic atrial RACE 7 ACWAS trial is provided in the fibrillation in the emergency department to be treated with a wait-and-see approach Supplementary Appendix, available at (delayed-cardioversion group) or early cardioversion. The wait-and-see approach in- NEJM.org. volved initial treatment with rate-control medication only and delayed cardioversion Drs.
    [Show full text]
  • Guide to Exercise Electrocardiogram
    Guide to the Exercise Electrocardiogram (The Treadmill Stress Test) An exercise stress test is performed to evaluate heart rate, heart rhythm, blood pressure and electrocardiographic (ECG) responses to progressive exercise. You do not need to be an athlete or to be trained to have this test for evaluation of your cardiovascular system, but you do need to be able to walk without support. The exercise ECG is used to evaluate the adequacy of blood supply to the heart during exercise that may be symptomatic or asymptomatic and to assess the extent of limitation of blood supply to the heart in people with known coronary artery disease. The test is also used to quantify effort capacity, to evaluate the effect of medications on symptoms and effort tolerance, to assess general health and prognosis, and to evaluate the heart rate and blood pressure responses to exercise before surgical procedures and before entry into programs of cardiac rehabilitation. Imaging of the heart with echocardiography or with radionuclide agents is not performed during basic exercise ECG unless prearranged by the referring physician. Pre-Registration and Testing Location Please call 2 days before the date your test is scheduled to confirm your appointment. At this time we can also answer questions you may have. Please have your referring physician complete the order form. Plan to arrive 20 minutes before the scheduled time of your test. Bring your hospital and insurance cards with you. Go directly to the test location. NewYork-Presbyterian Hospital/Weill Cornell Medical Center 212-746-4670 Exercise ECG Laboratory Starr Pavilion 520 East 70th Street, east of York Avenue New York, NY 10021 Take the Starr elevators to the 4th floor, follow the signs to room K-425.
    [Show full text]
  • Echocardiography to Supplement Stress Electrocardiography in Emergency Department Chest Pain Patients
    Original research Echocardiography to Supplement Stress Electrocardiography in Emergency Department Chest Pain Patients Mark I. Langdorf, MD, MHPE* * University of California, Irvine, Department of Emergency Medicine, Irvine, CA Eric Wei, MD† † University of Michigan, Ann Arbor, MI Ali Ghobadi, MD* Scott E. Rudkin, MD, MBA* Shahram Lotfipour, MD, MPH* Supervising Section Editor: David E. Slattery, MD Submission history: Submitted July 18, 2009; Revision Received February 21, 2010; Accepted March 24, 2010 Reprints available through open access at http://escholarship.org/uc/uciem_westjem Introduction: Chest pain (CP) patients in the Emergency Department (ED) present a diagnostic dilemma, with a low prevalence of coronary disease but grave consequences with misdiagnosis. A common diagnostic strategy involves ED cardiac monitoring while excluding myocardial necrosis, followed by stress testing. We sought to describe the use of stress echocardiography (echo) at our institution, to identify cardiac pathology compared with stress electrocardiography (ECG) alone. Methods: Retrospective cohort study of 57 urban ED Chest Pain Unit (CPU) patients from 2002- 2005 with stress testing suggesting ischemia. Our main descriptive outcome was proportion and type of discordant findings between stress ECG testing and stress echo.The secondary outcome was whether stress echo results appeared to change management. Results: Thirty-four of 57 patients [59.7%, 95% confidence interval (CI) 46.9-72.4%] had stress echo results discordant with stress ECG results. The most common discordance was an abnormal stress ECG with a normal stress echo (n=17/57, 29.8%, CI 17.9-41.7%), followed by normal stress ECG but with reversible regional wall-motion abnormality on stress echo (n = 10/57, 17.5%, CI 7.7- 27.4%).
    [Show full text]
  • Computer Processing of the Orthogonal Electrocardiogram and Vectorcardiogram
    Physiol. Res. 43: 95-98, 1993 Computer Processing of the Orthogonal Electrocardiogram and Vectorcardiogram L. BACHÂROVÀ Research Institute of Medical Informatics, Bratislava Summary The aim of this contribution was to review the possibilities of presentation of orthogonal ECG signals and to evaluate the progress in computerized electrocardiography achieved in Czechoslovakia. The information about the cardiac electric field in orthogonal electrocardiography is defined and consequently displayed as a fixed single dipole (vector). The spatial trajectory of vector end-point (spatial vectorcardiographic loop) can be presented in different ways — as orthogonal electrocardiogram, polarcardiogram, planar vectorcardiogram and decartogram, respectively. The advantages of particular methods of presentation, as well as their limitations are discussed. Computer-assisted electrocardiography was introduced in Czechoslovakia in 1974. The original AVA program has been further developed in the Research Institute of Medical Informatics (formerly Research Institute of Medical Bionics). The currently developed system CardioSys allows the utilization of all the possibilities of orthogonal ECG and vectorcardiographic presentation for clinical and epidemiological cardiology as well as for the research. Key words Orthogonal Electrocardiography - Vectorcardiography - Computer analysis The electrographic signal provides are the physiological source of electrocardiographic irreplaceable information about the status and activity potentials. The front of myocardial depolarization is in of the heart. In current clinical practice, it is mostly fact an electrical double-layer and, as such, may be registered by means of a standard 12-lead ECG system. represented by a set of regularly spaced unit vectors. However, the information obtained in this way is The vectorial sum of these unit vectors gives the characterized by a considerable redundancy.
    [Show full text]
  • June-July 2000 Part a Bulletin
    In This Issue... Disclosure of Itemized Statement Providers Must Furnish an Itemmized Statement when Requested in Writing by the Beneficiary .................................................................................................... 6 Prospective Payment System The Outpatient Code Editor Software Has Been Modified in Preparation for the Implementation of Outpatient Prospective Payment System ........................... 8 Reclassification of Certain Urban Hospitals Certain Urban Hospitals in the State of Florida May Be Permitted to Be Reclassified as Rural Hospitals................................................................................ 13 ulletin Final Medical Review Policies 33216, 53850, 70541, 82108, 83735, 87621, 93303, 94010, 95004, A0320, J0207, J2430, J2792, J3240, J7190, and J9999 .......................................... 15 B Payment of Skilled Nursing Facility Claims Involving a Terminating Medicare+Choice Plan Payment of Skilled Nursing Facility Care for Beneficiaries Involuntarily Disenrolling from M+C plans Who Have Not Met the 3-Day Stay Requirement ........................................................................................... 67 Features From the Medical Director 3 Administrative 4 lease share the Medicare A roviders PBulletin with appropriate General Information 5 members of your organization. Outpatient Prospective Payment System 7 Routing Suggestions: General Coverage 12 o Medicare Manager Hospital Services 13 o Reimbursement Director Local and Focused Medical Policies 15 o Chief Financial
    [Show full text]
  • Quantitative Electrocardiography for Prediction Of
    QUANTITATIVE ELECTROCARDIOGRAPHY FOR PREDICTION OF POSTOPERATIVE ATRIAL FIBRILLATION AFTER CARDIAC SURGERY by FLORIAN RADER, M.D. Submitted in partial fulfillment of the requirements For the degree of Master of Science Clinical Research Scholars Program CASE WESTERN RESERVE UNIVERSITY January 2010 CASE WESTERN RESERVE UNIVERSITY SCHOOL OF GRADUATE STUDIES We hereby approve the thesis/dissertation of Florian Rader, M.D. candidate for the Master of Science degree*. (signed) Regis E. McFadden (chair of the committee) Eugene H. Blackstone, M.D. Ottorino Costantini, M.D. Neal Dawson, M.D. (date) 10-28-2009 *We also certify that written approval has been obtained for any proprietary material contained therein. 2 Table of Contents List of Tables 4 List of Figures 5 Acknowledgments 6 List of Abbreviations 7 Abstract 9 Text Background and Significance 10 Specific aims 12 Methods 13 Results 21 Discussion 46 Limitations 54 Conclusions 54 References 55 3 List of Tables: Table 1: Patient characteristics 24 Table 2: Clinical predictors of postoperative atrial fibrillation 37 Table 3: ECG predictors of postoperative atrial fibrillation 38 4 List of Figures: Figure 1: Relationship of anatomic and ECG changes with POAF 11 Figure 2: Patient flow chart 22 Figure 3: Occurrence of POAF by days after surgery 33 Figure 4: Occurrence of POAF by surgery type 34 Figure 5: ROC curve of final prediction model 35 Figure 6: Calibration curve of final prediction model 36 Figure 7: Adjusted Co-plots of ECG predictors 39 Figure 8: Unadjusted and adjusted co-plot of P wave amplitude 41 Figure 9: Nomogram of final prediction model 42 Figure 10: Nomogram of prediction model with pre-op variables 43 Figure 11: Calibration curve of model without ECG predictors 45 Figure 12: Left atrial sizes by P wave amplitude in aVR 48 Figure 13: Correlation matrix (P wave amplitude, aVR, and left atrial volume) 49 5 Acknowledgments: I thank Dr.
    [Show full text]
  • NC Medicaid: 1R-4, Electrocardiography
    NC Medicaid Medicaid and Health Choice Electrocardiography, Clinical Coverage Policy No.: 1R-4 Echocardiography, and Amended Date: March 15, 2019 Intravascular Ultrasound To all beneficiaries enrolled in a Prepaid Health Plan (PHP): for questions about benefits and services available on or after November 1, 2019, please contact your PHP. Table of Contents 1.0 Description of the Procedure, Product, or Service ........................................................................... 1 1.1 Electrocardiography ............................................................................................................ 1 1.1.1 Electrocardiogram .................................................................................................. 1 1.1.2 Cardiovascular Stress Test ..................................................................................... 1 1.1.3 Microvolt T-wave Alternans .................................................................................. 1 1.1.4 Holter Monitor ....................................................................................................... 1 1.1.5 Cardiac (Ambulatory) Event Monitors .................................................................. 1 1.2 Echocardiography ............................................................................................................... 2 1.2.1 Transthoracic Echocardiography (TTE) ................................................................ 2 1.2.2 Transesophageal Echocardiography (TEE) ..........................................................
    [Show full text]
  • Chapter 2 the Electrocardiogram
    THE ESC TEXTBOOK OF CARDIOVASCULAR MEDICINE 2nd edition 17 Spodick DH. Differential characteristics of the C h a p t e r 2 The Electrocardiogram electrocardiogram in early repolarization and acute pericarditis. N Engl J Med 1976; 295 : 523–6. Francisco G. Cosío, José Palacios, 18 Watanabe Y. Purkinje repolarization as a possible cause of the Agustín Pastor, and Ambrosio Núñez U wave in the electrocardiogram. Circulation 1975; 51 : 1030–7. 19 Voukydis PC. Effect of intracardiac blood on the electrocardiogram. N Engl J Med 1974; 291 : 612–16. 20 Thomas P, Dejong D. The P wave in the electrocardiogram in the diagnosis of heart disease. Br Heart J 1954; 16 : 241–54. References 21 Kaplan JD, Evans T Jr, Foster E, et al . Evaluation of electrocardiographic criteria for right atrial enlargement by 1 Grant RP. Clinical Electrocardiography: The Spatial Vector quantitative two-dimensional echocardiography. J Am Coll Approach , 1957. New York: McGraw Hill. Cardiol 1994; 23 : 747–52. 2 Sodi D, Bisteni A, Medrano G. Electrocardiografi a y 22 Reeves WC, Hallahan W, Schwitter EJ, et al . Two-dimensional Vectorcardiografi a Deductivas , Vol. I, 1964. México DF: La echocardiographic assessment of ECG criteria for right atrial Prensa Médica Mexicana. enlargement. Circulation 1981; 64 : 387–91. 3 Rosenbaum MB, Elizari MV, Lazzari JO. The Hemiblocks , 1970. 23 Sgarbossa EB, Wagner G. Electrocardiography. In Topol EJ Oldsmar, FL: Tampa Tracings. (ed) Textbook of Cardiovascular Medicine , 2007. Philadelphia, 4 Cranefi eld PF. The Conduction of the Cardiac Impulse , 1975. PA: Lippincott Williams & Wilkins, pp.977–1011. Mount Kisko. NY: Futura. 24 Hazen MS, Marwick TH, Underwood DA.
    [Show full text]