1. Pre-ICU training

2. 工作態度 會客時主動告知病情 病歷每天書寫 2 次 主動反應問題 接觸病人前後洗手

3. AMI EKG, cardiac enzyme serially check Aspirin, Plavix, Enoxaparin CXR ACEI and B-blocker 視情形給與 MONA Intervention 的時機 Heart echo

4. CHF with pulmonary edema Nitrate + Diuretics and keep I/O negative ACEI O2 Correct hypoalbuminemia Swan-ganz monitor, pending

5. Swan-ganz

6. Indication Shock D/D Monitor fluid and C/O and adjust medication

10. TPM

11. Indication Bradycardia with symptom and refractory to medication

13. IABP

14. Indication A. cardiogenic shock –Bridge to revascularization –Bridge to tertiary center B. Refractory unstable angina C. Acute MI cathter based perfusion D. High risk percutaneous revascularization E.End stage cardiomyopathy/bridge to heart transplantation

15. Indication G. Mechanical complication of acute MI. Acute MR and VSD H.decompensated aortic stenosis I. Refractory ventricular arrythmias J. Weaning from cardiopulmonary bypass /post operative pump failure

16. Contraindication A. Aortic dissection B. Abominal or thoracic aneurysm C. Severe peripheral vascular disease D. Descending aortic and peripheral vascular graft E. Coagulopathy or contraindication to heparin F. moderate to severe aortic insufficiency

18. Complication A. Vascular –Ischemia –Bleeding B. Infection C. Balloon rupture D. Balloon entrapment E. RBC and platelet destruction F. Others

23. Red line represents actual pressure tracing with an initial systolic waveform followed by an pump generated waveform and then the systolic waveform seen following a balloon waveform with reduced systolic pressure

24. Figure 1b. Early inflation. May result in premature closure of aortic valve, increase in LVEDV and LVEDP, increased afterload, increased myocardial oxygen demand

25. Late inflation. Results in sub-optimal coronary perfusion.

26. Early deflation. Sharp drop following diastolic augmentation. Diastolic augmentation sub-optimal. Results in sub-optimal coronary perfusion, potential for retrograde coronary and carotid blood flow, sub-optimal afterload reduction and increase myocardial oxygen demand.

27. Late deflation. Afterload reduction almost absent. Increased myocardial oxygen demand du to LV ejecting against a greater resistance and a prolonged isovolumic contraction phase. Increased afterload.