| NEEDS STATEMENT
Identifying the indications for placing a pulmonary artery
catheter (PAC) for hemodynamic monitoring is surrounded by
controversy. Some clinicians rely on a PAC for all major cases,
whereas others eschew its use entirely. A critical appraisal of
the indications and contraindications for PAC placement has been
requested by readers and acknowledged by committee as important
information for anesthesiologists.
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| CASE HISTORY A
62-year-old man was scheduled for repair of an open aortic
aneurysm. His medical history was remarkable for coronary
artery disease, ischemic cardiomyopathy, systemic
hypertension, and hypercholesterolemia. He had undergone
percutaneous coronary interventions 3 and 5 years earlier
and coronary artery bypass grafting 1 year prior.
Transthoracic echocardiography 4 months previously had
shown a severely dilated left ventricle (LV), moderate
dysfunction in both ventricles, moderate to severe mitral
regurgitation, moderate tricuspid regurgitation, and
elevated right ventricular (RV) pressures. Systolic RV
pressure, estimated from the velocity of tricuspid
regurgitation, was 55 mm Hg. The patient reported
decreased exercise tolerance, dyspnea on climbing 1 flight
of stairs, and occasional dyspnea at rest. His
cardiologist confirmed poor patient compliance with
prescribed medications. However, given the urgent nature
of the procedure, no further interventions were possible
at the time to improve his cardiac status. The
cardiologist and surgeon both requested that a PAC be
placed before induction of anesthesia.
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LEARNING OBJECTIVES
At the end of this activity, the participant should be able to:
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List the indications for placement
of a PAC.
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Explain the clinical information
obtained from PAC placement.
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Describe the normal waveforms seen
during PAC placement.
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Recognize abnormal waveforms seen
during hemodynamic monitoring with a PAC.
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Discuss the contraindications to
PAC placement.
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Manage the complications that may
occur during and following placement.
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Identify less invasive
alternatives for hemodynamic monitoring than a PAC.
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Present a plan for PAC placement.
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Summarize the guidelines of the
American Society of Anesthesiologists regarding PAC use.
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Identify cases in which PAC
placement would be beneficial.
TARGET AUDIENCE: Anesthesiologists
INSTRUCTIONS FOR COMPLETING THIS COURSE
The estimated time to complete this activity is 2 hours. There
are two options for completing this CME activity.
Option 1: Exam Only. This option can only be
exercised by subscribers to Anesthesiology News who possess
a material copy of the course. Participants who select this
option must read the article in the journal, reflect on the information
presented, and then register to complete the exam and course evaluation
online before June 30, 2008. (CME credit is not valid past this
date.)
To register for the exam only, click on the Register For Exam link
located at the bottom of this page. DO NOT select this option if you
do not possess a material copy of the CME course material.
There are ten questions in the examination and you must achieve
a score of 80% or better to earn CME credit. Following successful
completion, your certificate will be immediately available online.
In addition, a historical record of completed CME courses is
maintained online in an individualized profile. This includes
copies of course certificates which can be printed at any time.
Option 2: Course Material and Exam. All participants
are eligible for this option.
You must first register for this course by clicking the "Register
for Course" link located at the bottom of this page. Course
material is presented in small digestible sections followed by exam
questions pertaining to the information in the segment covered.
As you read through the material on the course pages, you will occasionally
be prompted to answer exam questions.
There are several short pages of information and 10 multiple choice
questions presented in this course. You must achieve a minimum
grade of 80% (8 correct answers) to receive CME credit. The exam and
course evaluation must be completed before June 30, 2008. (CME
credit is not valid past this date.)
The course software does not permit you to page back from the exam
questions. You must be sure that you understand the material
presented on each page before proceeding.
When you have answered the last exam question, the Course Results
page will display. This page will contain your final grade and allow
you to immediately view/print your Certificate if you have achieved
the minimum passing score of 80%.
Upon successful completion, your Certificate will be available
at all times from your Student Control Panel. In addition,
a historical record of completed CME courses is maintained online
in an individualized profile. This includes copies of course
certificates which can be printed at any time.
The course does not need to be completed in a single online session.
You can log off at any point and return to the course at your convenience.
If you wish to obtain more information regarding the features of this
site, you may visit the Orientation page.
Click here to view Orientation.
REGISTRATION
The registration fee for this course is $15.00
Physicians are provided with two opportunities to complete the
course presented here.
Accreditation Statement
Mount Sinai School of Medicine is accredited by the Accreditation
Council for Continuing Medical Education (ACCME) to provide continuing
medical education for physicians.
Credit Designation: The Mount Sinai School of Medicine designates
each educational activity for a maximum of 2 AMA PRA Category 1 CreditsTM.
Physicians should only claim credit commensurate with the extent of
their participation in the activity.
It is the policy of Mount Sinai School of Medicine to ensure objectivity,
balance, independence, and scientific rigor in all CME-sponsored educational
activities. All faculty participating in the planning or implementation
of a sponsored activity are expected to disclose to the audience any
relevant financial relationships and to assist in resolving any conflict
of interest that may arise from the relationship. Presenters must
also make a meaningful disclosure to the audience of their discussions
of unlabeled or unapproved drugs or devices.
Dr. Kaye has disclosed that he is a member of the speakers’
bureau of Baxter. The authors and editor have no relationships
with pharmaceutical companies or manufacturers of products to
disclose. This educational activity may contain discussion of
published and/or investigational uses of agents for the treatment
of disease. Some uses of these agents have not been approved by
the FDA. Please refer to the official prescribing information for
each product for approved indications, contraindications, and
warnings.
CONTACT INFORMATION
Questions regarding course content may be directed to Dr. Elizabeth
Frost: ElzFrost@aol.com.
If you require technical assistance with completing this
course, please contact Continuing Education Online Customer Service
at 718-648-8080 or send e-mail to
CEO.support6@proceo.com.
All other requests for administrative assistance should be directed
to Josephine Greene in the CME office at the Mount Sinai School of
Medicine : 212-241-4441 or send email to
Josephine.Greene@msnyuhealth.org
CALL FOR WRITERS
If you would like to write a CME lesson in Anesthesiology News,
please send an e-mail to Elizabeth A.M. Frost, MD, at
ElzFrost@aol.com
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This option is for the examination
ONLY. No course material is provided. This option
is available for subscribers of Anesthesiology News who
possess a material copy of the course material. DO NOT select
this option if you do not have the course material. |
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This option is available for all participants. This option
includes a full online text version of the course material and
exam. |
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