1. Clinical Specialty Areas rev 2016-03-15 this is now slide 1do not print it to pdf things to do (check off when complete): add revision date to cover page remove triangles create list for pages to print in the handout 2-6,9,15-16,18,21-25,28,31-32,43-46,48,52,56 add captions for photo slides incorporate notes taken during presentation add Key Points page 3 useful characters: ° degrees‎Ω ohmsμ microλ lambda ☑ checkbox ☐ slash-zero ØCO 2 O 2 SpO 2 N 2 O ® ™ trademarks à 224 E0 á 225 E1 â 226 E2 ã 227 E3 ä 228 E4 å 229 E5 æ 230 E6 ç 231 E7 Ð 208 D0 è 232 E8 é 233 E9 ê 234 EA ë 235 EB ì 236 EC í 237 ED î 238 EE ï 239 EF Ñ 209 D1 Ò 210 D2 Ó 211 D3 Ô 212 D4 Õ 213 D5 Ö 214 D6 Ø 216 D8 ß 223 DF Þ 222 DE Ù 217 D9 Ú 218 DA Û 219 DB Ü 220 DC Ý 221 DD Þ 222 DE ß 223 DF

2. Clinical Specialty Areas © D. J. McMahon 150225rev cewood 2016-03-15

3. Key Points Clinical Specialty Areas: 1: Cardiac Catheterization Labs diagnostic: Coronary Angiography therapeutic: Angioplasty 2: Electrophysiology (EP) Labs problems and treatment of the conduction system of the heart diagnosis of arrhythmias and other abnormal ECGs 3: Sleep Study Labs multiple parameters are monitored stages of sleep; NREM & REM 4: Hyperbaric Chambers Hyperbaric Oxygen Therapy; HBOT Chambers can be “hard” or “soft” pressures can be up to 6 bar (~87 psi) Oxygen usually delivered in a ‘helmet’ sealed at the neck Chamber is pressurized with air (not oxygen) treatment of: decompression for nitrogen narcosis (“The Bends”) CO poisoningwound healing, esp gangrene burnsinfection abatement

4. 1: Cardiac Catheterization Labs Refs: http://www.youtube.com/watch?v=kY5gKdFWT3k Coronary Angiography (Cardiac Catheterization)2:40 http://www.youtube.com/watch?v=veP5R-pzJVk Angioplasty0:54

5. Cath labs as a diagnostic service: - Confirm suspected coronary artery disease or valve problems > inject contrast agents to visualize vessels and chambers - Measure intra-arterial and intra-ventricular pressures - Perform biopsies And as a therapeutic service: - perform balloon angioplasty > percutanenous transluminal cardiac angioplasty (PTCA) (through skin; across wall) - placement of stents

6. Major coronary arteries

9. Inserting a Stent

11. Stent

14. Fluoroscopy with C-armUltrasound

15. Major players in Cath Labs: - Philips (was Witt <2006) - GEMS(General Electric) - Siemens

16. http://www.youtube.com/watch?v=lvqa1xQkxzU 3-D Electrical Mapping of the Heart2:12 2: Electrophysiology (EP) Labs > Specifically concerned with problems and treatment of the conduction system of the heart > Diagnosis of arrhythmias and other abnormal ECGs > Treatment by - ablation of tissue with RF - placement of a pacemaker - placement of an automatic implantable cardioverter-defibrillator (AICD) - drugs

18. Electrode manipulated by two large magnets above and below the patient

21. Major players in EP Labs: (hardware and software) - GEMS (was Pruka) - Philips

22. 3: Sleep Study Labs

23. Sleep Studies have become a major business - Clinical indications – airway problems (snoring, obstructions) neurological disease (narcolepsy, Restless Leg Syndrome) - Obesity & life-style issues - Multiple clinics in every city now - Staffed by MD’s, RN’s, and PSG techs - Registered Polysomnograhic Techs - RPSGT Sleep deprivation has been involved in many major disasters, accounts for low productivity, social issues, psychological issues, etc.

25. Multiple parameters are monitored: EEG EOG (both sides )ocular EMG face muscles ECG SpO 2 Respiratory Effort Respiratory Gas Flows Limb Movement (EMG) Audio for snoring etCO 2 IR video cameras

31. Stages of Sleep: Non-REM (Rapid Eye Movement) Sleep (NREM) : Stage 1 - 5-10 minute transition from awake to sleepy, slowed EEG Stage 2 - Deep sleep, some thoughts and images; 50% of time Stage 3 - Deepest sleep, slowed heart rate & breathing, delta EEG only REM Sleep : - 20 – 25% of total sleep time - episodes of increasing length - little muscle tone, almost paralysis - irregular breathing, faster heart rate - increased brain O 2 consumption - dreaming

43. Sleep-Lab specific equipment makers: - Nicolet - Sandman - ProTech - Oxford - Embla - include software as well as hardware

44. 4: Hyperbaric Chambers “Hyperbaric Oxygen Therapy”: HBOT Used for treatment of - decompression for nitrogen narcosis (“The Bends”) - CO poisoning - wound healing, esp gangrene - burns - infection abatement

45. Chambers can be “hard” or “soft ” - most clinics use hard chambers - greater capacity, more efficient - soft chambers usually urethane-&-nylon coated acrylic with sealable zipper Oxygen usually delivered in a ‘helmet’ sealed at the neck Chamber is pressurized with air (not oxygen) - pressures can be up to 6 bar (~87 psi) - treatments can be 1 to 2.5 hours - depending on indications, patient may get 10 to 20 treatments - staff refer to each treatment as a “dive” - sessions can be from $500 to >$1000 each

46. Early chamber -- Portable chamber for diver transport -- Chamber for one patient --

48. Virginia Mason’s Hyperbaric Chamber --

53. Carbon monoxide poisoning –

54. Wound Treatment -

56. Medical devices in large Hyperbaric Chambers – - usually basic monitoring - typically SpO2, with ECG &/or NIBP - ventilator usually available - challenge is to connect the signal cables thru the chamber bulkhead for reading and recording outside - chamber conditions monitored separately