Lightning Lectures

• -Average lifespan of the pulse generator is 6-10 years
  • -Leadless pacemakers are in the works. Can help reduce many of the risks associated with current pacemakers
• -Indications for pacemaker placement include Sinus Node dysfunction, high degree AV block or high risk to progress to high degree AV block
• -Magnet placement will revert any pacemaker back to the factory rate
• -Iphone 12s and newer models are known to be strong enough magnets to revert to factory settings
• -When a pacemaker is malfunctioning, interrogation is usually the first investigative step

• -AAAs that are symptomatic or > ~5cm require surgical repair
• -Most common complication of AAA: rupture
• -Risk Factors for AAA include Male gender, Smoking, HTN, age >50
• -Gold standard for diagnosis is CT, however, US can also be quite sensitive
• -Overall Tx goal is reducing shearing stress. Aggressively control pain, HR and BP

Using Self-Directed Learning Skills To Pass The Boards The First Time

• -Nationally across all specialties 20% of residents fail boards on the first attempt
• -Self directed learning has 4 main parts: Define a goal, identify the steps, choose the best strategy and asses
• -Important to try to identify gaps in knowledge; can help to ask yourself reflective questions
• -Try to create frameworks to organize your knowledge
• -How to read to gain knowledge: Ask yourself 1. What did I just read? 2. Why was it important? 3. How does it connect to something I already know?

PGY2 Clinical Pathway: Pulmonary Embolism

• -Helpful to divide acute vs subacute vs chronic. Stable vs unstable. Saddle vs segmental vs subsegmental
• -Wide variety of presentations ranging from asymptomatic to profound shock
• -ABG can sometimes be helpful (unexplained hypoxia should raise suspicion)
• -EKG abnormal in up to 70% of cases, however specific findings can vary widely
• -CTPE is 90% sensitive.
• -Treatment dependent on a number of factors including hemodynamic status and bleeding risk
• -Empirically anticoagulate those with low risk of bleed and high pre-test probability of PE