Grand Rounds Recap 4.8.20

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Grand Rounds Recap 4.8.20

This week there were a number of underlying themes between pacemakers, MIs and leadership as well as some other high yield topics sprinkled in. Dr. Broadstock kicked us off with an educational lecture on pacemakers. We combined with our neurology colleagues to discuss how to best take care of basic neuro complaints in the ED in the time of COVID. R3s led an awesome small group on high sensitivity troponin. Dr. Banning shared the lessons she has learned through her own mistakes and failures. A truly heroic resuscitation for a patient in R heart failure by Dr. Skrobut in his Taming the SRU lecture. Lastly, learned about pediatric ophthalmology from Dr. Zamor.

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Transvenous Pacemaker Insertion - Part 3

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Transvenous Pacemaker Insertion - Part 3

We used Part 1 and Part 2 in this series to give you an in depth understanding of all the critical steps of the procedure.  After reading those posts you should have a good grasp of the indications for the procedure, the complications you may encounter, and you will have read, seen, and heard step by step instructions for placing a transvenous pacemaker in the ED. This final installment in the series should bring it all together for you.  Here you will see the placement of the transvenous pacemaker from start to finish from the point of view of the operator (Dr. J'Mir Cousar) all filmed in glorious HD.

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Transvenous Pacemaker: Part 2 - A Procedural Slide Set

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Transvenous Pacemaker: Part 2 - A Procedural Slide Set

worked to create a video walkthrough of the procedure.  The video walkthrough is divided into two separate videos.  The first, embedded below is a narrated procedural slide set, designed to be a cognitively unloaded approach to learning the procedure.  In a later post we'll see a full, start to finish video of the procedure filmed from the first person viewpoint.

In addition to the video being posted here, Dr. Cousar has constructed a checklist that will be placed on the pacemaker generator which will have a QR code to link to this narrated slide set.

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Transvenous Pacemaker Placement - Part 1: The Walkthrough

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Transvenous Pacemaker Placement - Part 1: The Walkthrough

If you are interested in seeing the placement of a Transvenous Pacemaker after reading this post check out Part 2 (Procedural Slide Set) and Part 3 (the first person view of the procedure)

Reasons to Pace in the First Place

Hemodynamically unstable+

1. Sinus Bradycardia - seen in 17% of acute MI patients (especially inferior or anterior wall MI) [1,2]

2. AV Block - may be due to ischemia (15-19% of all Acute MI) [2,3]

3. Drug Overdose - with the goal of maintaining adequate hemodynamics while your medical therapy/dialysis has an opportunity to work.

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