Cardiac surgery is a dangerous and complex field of medicine with significant morbidity and mortality. Quality anesthetic care with specific attention to detail can greatly enhance patient safety and outcome. Details that are ignored can lead to disaster. It is not all inclusive or definitive but it is the minimal critical requirements. A good reference is: Anesthetic evaluation must include attention to cardiac history. The cath report, thallium, echo, and ECG.
Electrodes, leads & wires
At the present time all bypass cases get the standard monitors plus an a-line, and a pa-catheter. As yet, this has not changed our practice. It is clear however that placement of PA catheters must be incredibly skillful without injury to other structures. With no proven benefit all risk must be reduced. One method to achieve this is ultrasonic mapping prior to catheter placement.
The perfusionists can give large amounts of crystalloid and we need to note it on the anesthesia record.
How quickly will I get the results? How does a Regular Stress Test Work? Patients with coronary artery blockages may have minimal symptoms and an unremarkable or unchanged EKG while at rest. However, symptoms and signs of heart disease may become unmasked by exposing the heart to the stress of exercise.
During exercise, healthy coronary arteries dilate develop a more open channel than an artery that has a blockage. This unequal dilation causes more blood to be delivered to heart muscle supplied by the normal artery. In contrast, narrowed arteries end up supplying reduced flow to it's area of distribution. This reduced flow causes the involved muscle to "starve" during exercise. The "starvation" may produce symptoms like chest discomfort or inappropriate shortness of breath , and the EKG may produce characteristic abnormalities.
Most commonly, a motorized treadmill is used for exercise, while a stationary bicycle is used in some exercise laboratories. When is a Regular Stress Test ordered? A regular stress test is considered in the following circumstances:
12-Lead ECG Placement
This ECG signal is only a few millivolts in amplitude. The finished project is shown in the first photograph below. The project was built using an Adafruit Menta kit plus a few additional parts. The Menta kit includes a Arduino ATMega P microprocessor with 32K of Flash memory and 2K of RAM memory plus an Altoids-type metal case which has enough room to fit a small numeric display, a potentiometer to adjust the heart rate, and three banana receptacles for the patient leads.
Reconstruction of the standard lead ECG from recordings using nonstandard activity-compatible proximal limb lead positions.
There is usually reciprocal ST depression in the electrically opposite leads. It may be impossible to differentiate these two conditions based on the ECG alone. Spodick in as a downward sloping TP segment with specificity for acute pericarditis. Is a normal variant commonly seen in young, healthy patients. The ST changes may be more prominent at slower heart rates and disappear in the presence of tachycardia. Note the ST elevation in leads with deep S waves — most apparent in V It is associated with extensive myocardial damage and paradoxical movement of the left ventricular wall during systole.
This pattern suggests the presence of a left ventricular aneurysm due to a prior anteroseptal MI.
Find out how electrocuting chickens , getting laboratory assistants to put their hands in buckets of saline , taking the ECG of a horses and then observing their open heart surgey , induction of indiscriminate angina attacks , and hypothermic dogs have helped to improve our understanding of the ECG as a clinical tool. He derived the word from the Greek for amber electra. It was known from ancient times that amber when rubbed could lift light materials.
If the patient is doing poorly, tell them not to take out the arterial cannula.
These wires break down into 2 groups: Positioning of the 6 chest leads The 6 leads are labelled as "V" leads and numbered V1 to V6. They are positioned in specific positions on the rib cage. To position then accurately it is important to be able to identify the "angle of Louis", or "sternal angle". To find it on yourself, place your fingers gently at the base of your throat in a central position and move your fingers downward until you can feel the top of the sternum, or rib cage.
From this position, continue to move your fingers downward until you feel a boney lump. This is the "angle of Louis". The angle of Louis is most easily found when the patient is lying down as the surrounding tissue is tighter against the rib cage. From the angle of Louis, move your fingers to the right and you will feel a gap between the ribs. This gap is the 2nd Intercostal space.
From this position, run your fingers downward across the next rib, and the next one. The space you are in is the 4th intercostal space. Where this space meets the sternum is the position for V1. Go back to the "angle of Louis" and move into the 2nd intercostal space on the left.
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This one is large enough, and comes with useful jumper wires. I suggest saving the jumper wires specifically for connecting the various stages of the design. I like that pack, since it's pre-cut and keeps your board tidy.
The large plastic pipe is full of fluid and hooked to the venous reservoir.
Lateral Lead Explained One of the most common questions regarding a lead ECG is why there are only 10 electrodes. A lead is a view of the electrical activity of the heart from a particular angle across the body. Think of a lead as a picture of the heart and the 10 electrodes give you 12 pictures. In other words, a lead is a picture that is captured by a group of electrodes.
If the patient cannot tolerate being flat, you can do the ECG in a more upright position. Instruct the patient to place their arms down by their side and to relax their shoulders. Move any electrical devices, such as cell phones, away from the patient as they may interfere with the machine. Shave any hair that interferes with electrode placement. This will ensure a better electrode contact with the skin. Rub an alcohol prep pad or benzoin tincture on the skin to remove any oils and help with electrode adhesion.
Electrode Application Check the electrodes to make sure the gel is still moist. Do not place the electrodes over bones. Do not place the electrodes over areas where there is a lot of muscle movement.
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The device must be patient-activated. The distinction between a monitor with and without presymptom loop. The availability of full hour attended coverage for certain specified services. Indications To detect, characterize and document symptomatic transient arrhythmias. To aid in regulating anti-arrhythmic drug dosage. To aid in the search for the cause of unexplained syncope, dizziness or giddiness.
That use should probably be for a redo CABG.
Figure 3 — Note the prominent enlargement of the second and third metacarpophalangeal joints arrows in the fingers of this patient with hemochromatosis arthritis who is making the "victory sign" while attempting to fully approximate the second and third fingers A. The loss of depressions between knuckle ridges of these joints arrows is notable when the same patient's closed fists are viewed B.
Symptoms and signs Most patients with symptomatic arthropathy of hemochromatosis present with chronic, indolent pain and joint stiffness; bony enlargement; and minimal signs of inflammation. The distribution of affected joints combined with the character of the arthritis offers important clues to the diagnosis. The arthropathy is generally symmetrical and polyarticular. A predilection for disease in the second and third MCP joints is notable, and enlargement of these joints is readily seen in the fingers when they are extended to form a V, as in the "victory" sign Figure 3.
Identifying and managing hemochromatosis arthropathy
Different numbers of wires A 3 wire cable red, yellow, green or red, yellow, black can only give you a choice of limb leads. A 4 wire cable red, yellow, green, black can only give you a choice of limb leads. A 5 wire cable red, yellow, green, black, white will give you limb leads plus a chest lead using the white wire - usually placed in the V1 position.
This is a versatile monitoring cable, if you have one and lend it out - you may not get it back.
Gravity is reliable, back pressure is not.
"Y" Start: Delta Run (12 Leads)
I mentioned above that for simple monitoring the red is on the right shoulder, yellow on the left shoulder and black at the apex.