Are we doing CPR wrong?

Did you ever wonder why we adjust for patient age and size for almost everything (meds, devices, intubations, casts) and yet we assume everyone should get compressions in the same place?!
When we first heard about u/s-guided compressions using transthoracic echo (TTE) many of us thought it was going to be near impossible. To our surprise – up to half of patients have decent A4C views that offer a glimpse at what is happening – and we have seen ETCO2 rise from 20 to 40  with correction of CPR position.
The limited evidence (mostly animal studies) is pretty compelling… then add the potential of improved views using TEE and suddenly intra-arrest care changes dramatically!
Check out this clip to learn more: https://vimeo.com/206051789
Better yet – want to discuss it? want to try it out on a simulator? Want to practice your scans?
Then register for SASKONO18 by going to www.sasksonic.com/sasksono
Deadline to register is Feb 15th, 2018!
Please forward this to anyone you think might be interested.
The Sasksonic team

Case of the Year – Just in time for the Holidays!

As we wrap up another great year at Sasksonic, we are thrilled to learn that one of our own recently took home POCUS-Toronto’s “Case of the Year” award!

USask EM’s Dr. Puneet Kapur (PGY5 EM, @Kapurp) was recognized for his stellar case submission involving identification and test performance of several transthoracic echo findings as they relate to identifying acute pulmonary embolism. Many of you have heard of the value of each of the following findings as they relate to distinguishing acute from chronic RV strain: Screen Shot 2017-12-20 at 9.39.03 AM

Here are clips from the actual case that show RV dilation in the PSL and McConell’s sign in the A4C. Despite these – it may remain challenging to reliably determine acute vs chronic strain (see details in the cited article below).

 

 

Well, don’t give up hope – introducing RVOT systolic excursion! This measurement is obtained using the parasternal short axis view at the level of the aortic valve.

 

Screen Shot 2017-12-20 at 9.34.22 AMIt appears that measuring RVOT systolic excursion (as a percentage of end-diastolic RVOT diameter minus end-systolic RVOT diameter divided by end-diastolic RVOT diameter) is both specific and highly sensitive for acute PE. Analysis of right ventricular outflow tract systolic excursion showed that a value <24.3% can be found in acute pulmonary embolism patients with 100% sensitivity and 95.56% specificity (AUC = 0.987, P < 0.0001).

Sounds promising – looking forward to hearing and learning more about this.

We’re proud of Puneet! And while we’re at it – big thanks to the team at POCUS-Toronto for giving trainees like Dr. Kapur an opportunity to learn and excel in emergency POCUS.

Want to learn more about RVOT systolic excursion and acute RV strain? Check out the article below:

  1. Lõpez-Candales A, Edelman K. Right ventricular outflow tract systolic excursion: A distinguishing echocardiographic finding in acute pulmonary embolism. Echocardiography. 2013;30(6):649-657. doi:10.1111/echo.12120.

 

Upcoming Courses

We’ve got a great line up of courses to heat things up during the winter months!

Echo Guided Life Support (EGLS) – Saskatoon, SK. Dec 8th, 2017-  registration is now open on the website. Register here

The EDE course (Plus) – North Battleford, SK, Jan 13th, 2018  – registration here

We will also be hosting another EGLS course on March 2nd in Saskatoon (as a pre conference workshop prior to SASKSONO18). Registration will open Dec 11, 2017.

Cheers,

The SASKSONIC Team