Pre-ICU training

• 工作態度• 會客時主動告知病情• 病歷每天書寫 2次• 主動反應問題• 接觸病人前後洗手

AMI

• EKG, cardiac enzyme serially check

• Aspirin, Plavix, Enoxaparin

• CXR

• ACEI and B-blocker 視情形給與• MONA

• Intervention的時機• Heart echo

CHF with pulmonary edema

• Nitrate + Diuretics and keep I/O negative

• ACEI

• O2

• Correct hypoalbuminemia

• Swan-ganz monitor, pending

Swan-ganz

Indication

• Shock D/D

• Monitor fluid and C/O and adjust medication

TPM

Indication

• Bradycardia with symptom and refractory to medication

IABP

Indication

• A. cardiogenic shock– Bridge to revascularization– Bridge to tertiary center

• B. Refractory unstable angina• C. Acute MI cathter based perfusion • D. High risk percutaneous revascularizatio

n• E.End stage cardiomyopathy/bridge to hea

rt transplantation

Indication

• G. Mechanical complication of acute MI. Acute MR and VSD

• H.decompensated aortic stenosis

• I. Refractory ventricular arrythmias

• J. Weaning from cardiopulmonary bypass /post operative pump failure

Contraindication

• A. Aortic dissection

• B. Abominal or thoracic aneurysm

• C. Severe peripheral vascular disease

• D. Descending aortic and peripheral vascular graft

• E. Coagulopathy or contraindication to heparin

• F. moderate to severe aortic insufficiency

Complication

• A. Vascular – Ischemia– Bleeding

• B. Infection

• C. Balloon rupture

• D. Balloon entrapment

• E. RBC and platelet destruction

• F. Others

Red line represents actual pressure tracing with an initial systolic waveform followed by an pump generated waveform and then the systolic waveform seen following a balloon waveform with reduced systolic pressure

                                                                      Figure 1b.Early inflation. May result in premature closure of aortic valve, increase in LVEDV and LVEDP, increased afterload, increased myocardial oxygen demand

Late inflation. Results in sub-optimal coronary perfusion.

Early deflation. Sharp drop following diastolic augmentation. Diastolic augmentation sub-optimal. Results in sub-optimal coronary perfusion, potential for retrograde coronary and carotid blood flow, sub-optimal afterload reduction and increase myocardial oxygen demand.

Late deflation. Afterload reduction almost absent. Increased myocardial oxygen demand du to LV ejecting against a greater resistance and a prolonged isovolumic contraction phase. Increased afterload.