Mechanical vs Manual CPR Chest Compressions

lucasWhen talking about Out of Hospital Cardiac Arrest (OHCA) there are really only three things that make a true difference on outcomes (i.e. survival and neurologic function):

  • High quality, non-interrupted CPR
  • Early defibrillation
  • Therapeutic hypothermia

The quality of CPR is often under appreciated and performed incorrectly (too slow and/or not hard enough).  With mechanical CPR, chest compressions are delivered uninterrupted and at a predefined depth and rate. In my own practice I have seen these devices being used more and more, but my questions is do these devices impact outcomes?


By |2019-09-10T13:35:31-07:00Oct 23, 2013|Cardiovascular, Critical Care/ Resus|

Acute Pulmonary Embolism: Size does matter and ECG can give us clues


Acute pulmonary embolism (PE)  is a common condition that can be both severe and difficult to diagnose. Half of all acute PE cases are diagnosed in the emergency department, and acute PE follows acute coronary syndrome as the second most common cause of sudden unexpected death in outpatients. Also, right ventricular dysfunction is a consequence of massive/submassive acute pulmonary embolism and correlates with a poor prognosis and high mortality rate. Although an ECG lacks both sensitivity and specificity for acute PE, there are some clues that can help in determining the size of an acute PE.


By |2019-09-10T13:35:37-07:00Oct 8, 2013|Cardiovascular, ECG, Pulmonary|

Patwari Academy videos: LVADs


Complications from left ventricular assist devices (LVAD) increasingly account for Emergency Department visits. What are LVADs? They are a short-term, artificial, circulatory device which performs the function of a very poorly functioning heart. It is important to understand the myriad of complications that can arise and the general approach to patients with an LVAD. These two short videos by Dr. Rahul Patwari summarize these in a nutshell.


By |2019-01-28T21:55:07-08:00Sep 22, 2013|Cardiovascular, Patwari Videos|

Door to Balloon Time: Are We Measuring the Right Thing?

human_heart_bandaid_pc_1600_clr_1770Door-to Balloon (D2B) time is a time measurement that starts with patient arrival to the emergency department (door) and ends when a catheter crosses a culprit lesion in the cardiac cath lab (balloon). The benefit of prompt primary percutaneous coronary intervention over thrombolytic therapy for acute ST elevation myocardial infarction is very well established. Because of this “time is muscle” strategy, the American College of Cardiology (ACC) launched a national Door to Balloon (D2B) initiative in November 2006. The purpose of this was to recommend a D2B time of no more than 90 minutes. Currently, there is quite a bit of effort put into this guideline by cardiology and emergency medicine, but are we measuring the right thing?


By |2019-09-10T13:35:47-07:00Sep 12, 2013|Cardiovascular|

High Sensitivity Troponin Testing

Lab_blooddraw copyTroponin testing is an important component of the diagnostic workup and management of acute coronary syndromes (ACS). The increasing sensitivity of troponin assays has lowered the number of potentially missed ACS diagnoses, but this has also created a diagnostic challenge due to a decrease in the specificity of the test. From 1995 to 2007, the limit of troponin detection fell from 0.5 ng/mL to 0.006 ng/mL (see below graph). Robert Jesse summed up this frustration with the following quote:

When troponin was a lousy assay it was a great test, but now that it’s becoming a great assay, it’s getting to be a lousy test.



By |2019-09-10T13:35:54-07:00Sep 5, 2013|Cardiovascular|

Bundle Branch Blocks (BBBs) 101

722px-Electrical_conduction_system_of_the_heartRecently, I have been asked by several students at my home institution (UTHSC at San Antonio) to help them understand bundle branch blocks.  This is different than some of my usual posts because it is meant to be more educational than evidence based.  So here we go.  The normal conduction system of the healthy heart is shown to the right.  If there is a delay or block in the left or right bundle, depolarization will take longer to occur. Therefore we get a widened QRS (>0.12 sec or >3 small boxes).


R-Wave Peak Time (RWPT) in Lead II: One Simple Step to Differentiate Wide Complex Tachycardias

RWPT-VT-2There are several algorithms that are currently used to help distinguish Supraventricular Tachycardia (SVT) with aberrancy and Ventricular Tachycardia (VT). Many of these algorithms lack specificity, and let’s face it, who can remember if the absence of an RS complex in the precordial leads is VT or SVT with aberrancy. So what if there was a criterion that had a good sensitivity (SN), specificity (SP), and was one simple step?


By |2019-09-10T13:36:27-07:00Aug 28, 2013|Cardiovascular, ECG|
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