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12/23/2022
A 101-year-old patient suffered cardiac arrest shortly after arriving to the ICU. CPR and ACLS initiated. This clip was recorded in the first pulse check that images were recorded.
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What would you recommend to the team leader?
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The TTE clip of the SLAX view demonstrates ventricular fibrillation.
You should recommend to the team leader to shock the patient.
Point-of-care ultrasound (POCUS), is a widely used in the management of critically ill patients. In this regard, the utility of POCUS in cardiac arrest is gaining interest.
Integration of POCUS in ACLS and CPR requires training and should not interfere with the protocols. Specifically, it should not extend the maximum 10-seconds pulse check.
In the setting of cardiac arrest, POCUS can rule out some of the causes of arrest – tamponade, PE leading to arrest, severe "pump failure", severe hypovolemia and pneumothorax. In addition, ventricular fibrillation or other arrythmias can be seen with ultrasound.
While there is no scientific evidence yet, sometimes it can shorten the duration of pulse check by quickly demonstrating VF like in this example.
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09/24/2021
What is the mitral valve area of this patient? Is there stenosis? If yes, how severe?
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The area of a normal mitral valve is 4-6 cm2, allowing for a large amount of blood to flow across the valve from the LA to the LV.
As the valve becomes stenotic, mean LA pressure increases and therefore, the degree of mean pressure gradient correlates with the degree of stenosis.
Mean gradient (mmHg):
< 5: Mild stenosis
5-10: Moderate stenosis
>10: Severe stenosis
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Mitral Valve Area (MVA) Calculations:
Commonly, MVA calculation of a native valve is calculated using the pressure half-time (PHT), which was originally developed and used in the cardiac catheterization lab.
PHT is defined as the time required for the peak pressure gradient between the LA and LV to be reduced by half. In contrast to the Cath Lab, with Doppler imaging the velocity, rather than pressure is measured. PHT is a useful measure of severity of disease progression. As stenosis worse, PHT increases, which leads to slower decrease in diastolic velocity.
Empirically, it was found that MVA is approximately equal 220 divided by PHT:
MVA = 220/PHT
MVA = 220/202 = 1.0 cm2
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