Vikas Bhalla MD, MBA, MSCR, RPVI, FACC Halo! the unroll you asked for: Ashish Pershad: Post infarct apical VSD closure -2 weeks post anterior mi and 1 week on IABP with no end organ damage-… threadreaderapp.com/thread/1309218… Talk to you soon. 🤖

Learn the latest in patient preparation to help you get the best images for your patients in this session at Heart_SCCT #SCCT2021 chaired by Chandana Shekar and Michael Steigner - register at scct.org/page/SCCT2021V… #YesCCT

Starting soon! Ch.3⃣ 1:15pm #SCCT2021 Chance Favors the Prepared: #YesCCT Exam Prep & Safety -Preppy premeds...D.Groves -Rad to da bone...A.Einstein -Y u gotta be so complicated? C.Maroules -We need to talk...J.Jacobs -Letter of da law...J.J. Carr -All in due process...Q.Truong

#SCCT2021 "Chance Favors the Prepared: Exam Prep & Safety" #YesCCT Pt Prep & Premeds by Dr. Daniel Groves University of Colorado 🧵:

#SCCT2021 #YesCCT 1) Considerations: patient selection & preparation - clinical stability/ability to tolerate scan? - contrast allergy? - renal dysfxn? - pregnancy? - contraindications to BB/NTG? - ⬇️HR to ⬇️motion artifact &☢️dose

#SCCT2021 #YesCCT 2) Pre-Meds to ⬇️HR: - cardioselective beta blocker (metoprolol, esmolol) - non-dihydropyridine CCB (diltiazem, verapamil) - ivabridine (don't use in AFib)

#SCCT2021 #YesCCT 3) Nitrates: ⬆️diagnostic accuracy - administer 3-5 min prior to CCTA - avoid sildenafil (24 hours) and tadalafil (72 hours)

#SCCT2021 #YesCCT 4) Contrast Allergy Premeds: - 💊Prednisone 50mg 13/7/1 hr b4 OR Methylprednisolone 32mg 12/2 hr b4, ➕Diphenhydramine 50mg 1 hr b4 - 💉Methylprednisolone 40mg OR Hydrocortisone 200mg OR Dexamethasone 7.5mg Q4hr until contrast, ➕Diphenhydramine 50mg 1 hr b4

x.com/DavidJHur1/sta…

#SCCT2021 #YesCCT 5) At the scanner -🪒chest if need be - prep pad 🧽 the skin prior to electrodes - want👍ECG⚡️tracing (tall R waves!) - practice 🫁 holding

x.com/DavidJHur1/sta…

#SCCT2021 "Chance Favors the Prepared: Exam Prep & Safety" #YesCCT Rad to the 🦴(🫁 🫀) by Dr. Andrew Einstein Andrew Einstein ColumbiaCardiology 🧵:

#SCCT2021 #YesCCT 4) Is k-factor of 0.014 invoked in older guidelines outdated? - in contemp studies using modern dosimeters & physical anthropomorphic phantoms, k-factors ranged 0.020-0.043 - as of 2018, for adult CT exams confined to 🫀, average k-factor ought to be 0.026

#SCCT2021 #YesCCT 5) Effective doses remain variable and high, and thus there remains ongoing push to keep bringing doses down further

#SCCT2021 "Chance Favors the Prepared: Exam Prep & Safety" #YesCCT Why you gotta be so complicated? by Dr. Christopher Maroules Chris Maroules 🧵:

#SCCT2021 #YesCCT 3) Acute adverse rxns - generally occur w/in 20 min of contrast admin/exposure - allergic rxns: oxygen, epinephrine, albuterol - physiologic rxns (vasovagal): leg elevation, IVF, atropine

#SCCT2021 #YesCCT 4) Contrast extravasation - RF: distal site injections & abnl circ - sequelae: self-limited (24-48h), but can lead to skin comps & compartment syndrome (severe) - eval: 👀promptly, focused exam - TX: ⬆️above 🫀, compress, conting instructions, surgery if c/f CS