Grand Rounds this week focused on pulmonary hypertension review and cardiac devices, presented, respectively, by Dr. Ganesh of the pulmonology service and by our very own Dr. Aarti Jain.
Dr. Ganesh of the pulmonology service gives an overview of pulmonary hypertension, including management in the emergency setting. Take home points include that patients on continuous infusion of pulmonary vasodilators who have pump malfunction may crash quickly, and these medications are only available in tertiary or quaternary referral centers. Call their specialists and arrange for transfer.
Also, the preferred vasopressors for patients with pulmonary hypertension who are hypotensive include milrinone, dobutamine, and epinephrine. When in doubt, and if they are profoundly hypotensive, start with epinephrine. Avoid intubation if at all possible, and consider allowing patients to fly with oxygen saturation in the 80s if they appear able to maintain those sats.
Watch Dr. Ganesh in action. Perhaps the most high-yield portion of the video is at the end during the Q&A session!
Pacemaker panic is an outstanding PGY3 talk presented by Dr. Aarti Jain. She reviews how to tell what kind of cardiac device is implanted. Also, if a patient with a device presents with chest pain, get a 2-view CXR, EKG, lytes, and interrogate the pacer. Grab that magnet if the patient is unstable! Tune in to the video for many more priceless pearls!