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1/6 #SpokeAndHub #Shock story: 50s Diabetes presents with acute chest discomfort/dyspnea. ECG global ischemia. HR 100s, BP 90s. Cath below at #Spoke Hospital. EF 45% by LV Gram...
2/6 IVUS demonstrates heavy calcium. Femoral Swan and IABP placed. Heparin drip. Aggrastat drip. Low dose NorEpi drip. Stable. Pain-free. #ShockTeam consult. Xferred from #Spoke (me) to #Hub (also me) facility for CABG after #HeartTeam discussion...
3/6 Femoral swan out during xport
. IABP site bleed in #CICU: unsuccessfully tx with FemStop but successfully (and easily) tx bedside with minimal forward sheath advancement ( #ProTip [below] courtesy of @J_M_McCabe). In interim: pressors piled on/mode of revasc “reconsidered”...
![3/6 Femoral swan out during xport. IABP site bleed in #CICU: unsuccessfully tx with FemStop but successfully (and easily) tx bedside with minimal forward sheath advancement ( #ProTip [below] courtesy of @J_M_McCabe). In interim: pressors piled on/mode of revasc “reconsidered”...](https://pbs.twimg.com/media/EZClicAXgAEbXxj.jpg "3/6 Femoral swan out during xport. IABP site bleed in #CICU: unsuccessfully tx with FemStop but successfully (and easily) tx bedside with minimal forward sheath advancement ( #ProTip [below] courtesy of @J_M_McCabe). In interim: pressors piled on/mode of revasc “reconsidered”...")
![3/6 Femoral swan out during xport. IABP site bleed in #CICU: unsuccessfully tx with FemStop but successfully (and easily) tx bedside with minimal forward sheath advancement ( #ProTip [below] courtesy of @J_M_McCabe). In interim: pressors piled on/mode of revasc “reconsidered”...](https://pbs.twimg.com/media/EZClicVWAAAQNFK.jpg "3/6 Femoral swan out during xport. IABP site bleed in #CICU: unsuccessfully tx with FemStop but successfully (and easily) tx bedside with minimal forward sheath advancement ( #ProTip [below] courtesy of @J_M_McCabe). In interim: pressors piled on/mode of revasc “reconsidered”...")
![3/6 Femoral swan out during xport. IABP site bleed in #CICU: unsuccessfully tx with FemStop but successfully (and easily) tx bedside with minimal forward sheath advancement ( #ProTip [below] courtesy of @J_M_McCabe). In interim: pressors piled on/mode of revasc “reconsidered”...](https://pbs.twimg.com/media/EZClid6X0AIf4Hm.jpg "3/6 Femoral swan out during xport. IABP site bleed in #CICU: unsuccessfully tx with FemStop but successfully (and easily) tx bedside with minimal forward sheath advancement ( #ProTip [below] courtesy of @J_M_McCabe). In interim: pressors piled on/mode of revasc “reconsidered”...")
. IABP site bleed in #CICU: unsuccessfully tx with FemStop but successfully (and easily) tx bedside with minimal forward sheath advancement ( #ProTip [below] courtesy of @J_M_McCabe). In interim: pressors piled on/mode of revasc “reconsidered”...
4/6 Back to Lab (with Surgeons in control room for #MultiDisciplinary chat). New Swan in (IJ). Swan/hemodynamic-guided volume (blood/IVF) resuscitation and down-titration of pressors (to nearly zero) in Cath Lab. IABP repositioned. Repeat angiography...
5/6 Repeat in-lab #HeartTeam chat now that patient stabilized: Impella-Rota-PCI vs. CABG? Group opted for CABG (young age, DM). Now...near-normalized EF, daily 1 mile walk... #UnblinkingEye #TeamOfTeams #SpokeAndHub
6/6 How do some borderline patients succumb to #Shock? Delayed decision-making and delayed action. Inadequate attention (and response) to bleeding. Too infrequent serial reassessments. Insufficient use of hemodynamics to guide therapies. Suboptimal Heart Team communication...
