Is a Cuff Enough?

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Is a Cuff Enough?

Sepsis is a leading cause of mortality for hospitalized patient’s both worldwide and in the United States.  The surviving sepsis guidelines weakly recommend invasive arterial blood pressure monitoring (IABP) over noninvasive blood pressure monitoring (NIBP) with a blood pressure cuff supported by low quality evidence.(1) Data comparing the accuracy between IABP and NIBP measurements are limited. The largest analysis of 736 critically ill patients found a mean difference of 1 mmHg which was not statistically significant, however, there was only one measurement recorded per patient.(2) Arterial lines have several drawbacks compared with non-invasive methods such as: training requirements for caregivers, potential for pain and increased pain medications, limitation of participation in physical therapy, risk of digital ischemia, and risk of iatrogenic infection.(3) In this journal club recap, we analyze an article looking at the relationship between invasive arterial line blood pressure readings and non-invasive cuff measurements.

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Grand Rounds Recap 3.27.24

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Grand Rounds Recap 3.27.24

We had an excellent Grand Rounds this week! Dr. Yates led our monthly Morbidity & Mortality Conference discussing pathology ranging from Dabigatran overdose to acute limb ischemia. We had an exciting CPC with hypomagnesemia presenting as new onset psychosis with Drs. Joshi & Lang. Finally, Dr. Gallen led a lecture and small group discussion on tracheostomies and their complications.

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Under Pressure - Compartment Syndrome Diagnostics

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Under Pressure - Compartment Syndrome Diagnostics

Compartment syndrome is a surgical emergency that can present after a variety of insults, ranging from those we commonly encounter in the ED (fractures, crush injuries) to more rare clinical presentations (snake bites, electrocution). The initial elevation of compartment pressures can be secondary to internal (ex. bleeding, swelling, fluid overload) and/or external (ex. compressive devices, burn eschar) factors. In this post, we detail the history/physical and diagnostic evaluation of possible compartment syndrome.

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The Anatomy of Femoral Vascular Access

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The Anatomy of Femoral Vascular Access

Prior to the widespread availability of point-of-care ultrasonography, invasive medical procedures were performed by the “landmark method”.  Landmark methods are based on surface anatomy, palpation, and sometimes trigonometry, and are fraught with the potential for error.  Complications, while unquantified in the misty past, were likely much more common than in the current era of readily available bedside imaging.  Vascular access procedures are inarguably safer and more successful when guided by sonography, but interpretation of ultrasound images still requires an understanding of both surface and deeper anatomy to relate the two-dimensional screen image to three-dimensional reality.  Further, there are circumstances where either the urgency of the resuscitation, or compromised access to the patient, requires that vascular access be obtained using landmarks rather than real-time imaging.  In such cases a detailed understanding of regional anatomy is critical to maximize procedural success and minimize complications.

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