John P. Howe

Pulmonary Embolism, Pulmonary Hemorrhage and Pulmonary Infarction

We compared 41 patients with angiographic proof of pulmonary embolism and clinical signs of pulmonary infarction (as evidenced by an infiltrate on x-ray study and pleuritic pain in the area of the embolus) with 24 patients with pulmonary embolism but without infarction. Only 18 of the 41 patients with pulmonary infarction had associated heart disease. Pulmonary infarction was uncommon when emboli obstructed central arteries but frequent when distal arteries were occluded. Follow-up x-ray examination showed that the infiltrates resolved in the patients with pulmonary infarction without heart disease, but persisted when heart disease was present. We suggest that obstruction of distal arteries results in pulmonary hemorrhage owing to an influx of bronchial arterial blood at systemic pressure. Hemorrhage causes symptoms and x-ray changes usually attributed to pulmonary infarction. However, hemorrhage resolves without infarction in patients without, but progresses to infarction in those with, heart disease.

Fibrin Split Products in Acute Pulmonary Embolism

Abstract The concentration of fibrin split products (FSP) was measured, by using a modification of the staphylococcal clumping test, in 46 patients who had pulmonary angiography for suspected acute...

Alteration of Systolic Time Intervals in Right Ventricular Failure

Systolic time intervals (STI) were measured in matched patients with and without right ventricular failure (RVF). STI were calculated from brachial arterial pressure tracings obtained at cardiac catheterization in four groups of patients: 1) controls, without RVF; 2) acute pulmonary embolism with and without acute RVF; 3) mitral stenosis, with and without chronic RVF; 4) primary pulmonary hypertension, with chronic RVF.In patients with pulmonary embolism without acute RVF, STI were normal. However, patients with acute RVF due to pulmonary embolism had significantly shortened left ventricular ejection times (LVETc) and significantly increased pre-ejection periods (PEPc) and increased PEPc/LVETc ratios (P < 0.05, P < 0.001, P < 0.001 respectively).Similar results were obtained in patients with chronic RVF. In patients with mitral stenosis without RVF, STI were normal. However, in patients with chronic RVF due to mitral stenosis or primary pulmonary hypertension, PEPc and PEPc/LVETc ratios were lengthened and LVETc was shortened (P < 0.003, P < 0.005, and P < 0.001 respectively).PEPc/LVETc ratios increased as stroke index decreased (r = −0.55). There was also an association between PEPc/LVETc and right atrial mean pressure (r = 0.70). These data demonstrate that patients with acute and chronic right ventricular failure have abnormal systolic time intervals possibly secondary to left ventricular dysfunction.

CPR Training for Physicians

In 1978, the Joint Commission on Accreditation of Hospitals determined that as a requirement for accreditation a hospital must demonstrate that all physicians on its staff have had training in card...

Evaluation of an emergency cardiac transport system

A university-based cardiac transport system was developed for the safe transfer of critically ill cardiac patients from community hospitals to a tertiary care facility. During the first year of operation, 50 patients were transported, 41 (82%) by ambulance and 9 (18%) by helicopter, from 24 hospitals in four New England states. The average response time from hospital request to transport team arrival was 75 minutes. Seventy-eight percent of these patients were unstable at the time of transfer. Hypotension or cardiogenic shock (39%), ventricular tachycardia or fibrillation (16%), and severe and recurrent chest pain (12%) were the most common conditions for which the team was summoned. Forty-six percent required invasive procedures for stabilization prior to transport, and one-third of patients required active intervention, including defibrillation, during transfer to the tertiary care facility. The majority (62%) of transferred patients underwent significant hospital procedures, and 75% of admitted patients were discharged from the hospital. Our initial experience indicates that transport of critically ill cardiac patients in need of advanced care can be accomplished in a rapid and efficient manner with a relatively good short-term prognosis.

How to Effectively Implement a Peer Review Process for Interventional Radiology Procedures

INTRODUCTION Fundamental to improving the quality of patient care is the process of gathering data and summarizing it in a reliable and easily accessible fashion, both for understanding existing conditions and for assessing subsequent improvement efforts. Our Department of Radiology has increasingly relied on tracking quality data to find ways to improve the way we operate and, ultimately, the way patients are cared for at our institution. Recently, our department has focused its quality improvement efforts on employing a system of peer review for each subspecialty in radiology. Although some consider the concept of peer review to be a flawed process with little evidence available in support of its benefits, the greater availability of quality data and the increased pressure on institutions from payers, employers, peers, and patients to clearly and concisely measure the performance of its health care providers have prompted the continued implementation and adaptation of the system [1-3]. As in any other field of medicine in which decisions or assessments are based on a multitude of factors, not all of which are easily quantifiable, implementing a successful peer review system in the interventional radiology (IR) subspecialty has been challenging [4]. Although it may be difficult to implement, peer review in this subspecialty could be particularly