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Shock

    • Early recognition of shock is difficult but essential for preservation of cellular and organ function and survival. The earliest clinical signs are nonspecific, with the initial inflammatory response including tachycardia, fevers, or cool or clammy skin. 
    • The approach to shock ultimately requires understanding and correcting its etiology (eg, antibiotics and source control for sepsis, thrombectomy after massive pulmonary embolus, hemorrhage control after trauma, and so forth). However, until these are diagnosed and addressed directly, clinicians ultimately have three approaches in their armamentarium: volume expansion, vasopressors, and cardioactive agents.
    • The PAC was introduced in 1970. Its use increased over the next 3 decades and eventually was considered the standard of care for most critically ill patients. However, the use of PACs declined rapidly after the results of the randomized, controlled trial published in the New England Journal of Medicine revealing no benefit in high-risk surgical patients.

Shock

    • Early recognition of shock is difficult but essential for preservation of cellular and organ function and survival. The earliest clinical signs are nonspecific, with the initial inflammatory response including tachycardia, fevers, or cool or clammy skin. 
    • The approach to shock ultimately requires understanding and correcting its etiology (eg, antibiotics and source control for sepsis, thrombectomy after massive pulmonary embolus, hemorrhage control after trauma, and so forth). However, until these are diagnosed and addressed directly, clinicians ultimately have three approaches in their armamentarium: volume expansion, vasopressors, and cardioactive agents.
    • The PAC was introduced in 1970. Its use increased over the next 3 decades and eventually was considered the standard of care for most critically ill patients. However, the use of PACs declined rapidly after the results of the randomized, controlled trial published in the New England Journal of Medicine revealing no benefit in high-risk surgical patients.

Cardiac Arrhythmias, Acute Coronary Syndromes, and Heart Failure in the Surgical Patient

    • To recognize and treat important cardiac arrhythmias in the surgical patient using the latest advances
    • Most up to date guidelines in management of Acute Coronary Syndrome (ACS) in Surgical Patients
    • Recent progress in management ofheart failure in postoperative and traumatic patients

Cardiac Arrhythmias, Acute Coronary Syndromes, and Heart Failure in the Surgical Patient

    • To recognize and treat important cardiac arrhythmias in the surgical patient using the latest advances
    • Most up to date guidelines in management of Acute Coronary Syndrome (ACS) in Surgical Patients
    • Recent progress in management ofheart failure in postoperative and traumatic patients

Cardiac Arrhythmias, Acute Coronary Syndromes, and Heart Failure in the Surgical Patient

    • To recognize and treat important cardiac arrhythmias in the surgical patient using the latest advances
    • Most up to date guidelines in management of Acute Coronary Syndrome (ACS) in Surgical Patients
    • Recent progress in management ofheart failure in postoperative and traumatic patients

Supraventricular Tachycardia

    • The REVERT trial concluded that a modified valsalva maneuver has a higher rate of cardioversion than historical vagal maneuvers.
    • In a patient with stable SVT where vagal maneuvers have failed, IV adenosine remains the first-line pharmacologic agent.
    • Combining adenosine and saline in a single syringe, rather than administration of adenosine followed by a saline flush, has been proven to be an effective form of administration.

Cardiac Arrhythmias, Acute Coronary Syndromes, and Heart Failure in the Surgical Patient

    • To recognize and treat important cardiac arrhythmias in the surgical patient using the latest advances
    • Most up to date guidelines in management of Acute Coronary Syndrome (ACS) in Surgical Patients
    • Recent progress in management ofheart failure in postoperative and traumatic patients

Supraventricular Tachycardia

    • Radiofrequency ablation as a treatment modality has revolutionized therapy for many SVTs; acts as a first-line alternative to drug therapy in some circumstances, with a high acute success rate and relatively low complication rate.
    • Cryoablation therapy emerging as an alternative in ablative therapies. Investigation of this modality for SVTs is ongoing.
    • Detailed drug regimens optimized for acute and chronic management of specific SVTs; detailed in the 2015 ACC/AHA/HRS practice guidelines.
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