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",{"id":215,"name":216},1,"Course previews",[218,229,234,239],{"type":219,"data":220},"video",{"readDurationInSeconds":221,"video":222},250,{"platform":223,"name":224,"url":225,"size":226},"YouTube","Arterial access complications","https:\u002F\u002Fwww.youtube.com\u002Fwatch?v=F8LfeZwmq-Q",{"width":227,"height":228},200,113,{"type":230,"data":231},"free_text",{"readDurationInSeconds":232,"text":233},6.933333333333334,"\u003Cp> \u003Cstyle type=\"text\u002Fcss\">\u003C!--td {border: 1px solid #ccc;}br {mso-data-placement:same-cell;}--> \u003C\u002Fstyle> Complications that arise following a PCI can be difficult to spot. In this video, you'll learn how to identify and manage PCI complications such as pseudoaneursyms, hematomas, retroperitoneal hemorrhage, and distal embolization.\u003C\u002Fp>",{"type":230,"data":235},{"readDurationInSeconds":236,"title":237,"text":238},18.4,"Join our Percutaneous Coronary Intervention Essentials course today!","\u003Cp>Perform your own PCIs with our \u003Ca href=\"https:\u002F\u002Fwww.medmastery.com\u002Fcourse\u002Fpercutaneous-coronary-intervention-essentials\">Percutaneous Coronary Intervention Essentials\u003C\u002Fa> course. You’ll cover essential PCI equipment, lesion assessment, troubleshooting, and patient monitoring so that you can perform your own procedures under the supervision of an experienced cardiologist. This course will debunk common myths surrounding PCI patient selection so that you can offer it to more patients who need it. Get your \u003Ca href=\"https:\u002F\u002Fwww.medmastery.com\u002Fuser\u002Fregister\">FREE trial account\u003C\u002Fa> and start Chapter 1 now!\u003C\u002Fp>",{"type":230,"data":240},{"readDurationInSeconds":241,"title":242,"text":243},96.26666666666667,"Video Transcript","\u003Cp dir=\"ltr\">\u003Cb id=\"docs-internal-guid-2088373c-7fff-b5ca-b99d-b39bd6fe534c\">[00:00:00] \u003C\u002Fb>Pseudoaneurisms or false aneurisms can form in any part of the arterial circulation as a result of iatrogenic trauma weakening the wall. They are characterized by swelling, pulsation, pain, and bruits on auscultation. An urgent ultrasound should be requested to confirm the presence of a pseudoaneurysm. Pseudoaneurisms can initially be managed\u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cb id=\"docs-internal-guid-2088373c-7fff-b5ca-b99d-b39bd6fe534c\">[00:00:30] \u003C\u002Fb>symptomatically with analgesia. They can then be manually compressed preferably under ultrasound guidance or injected with thrombin if they have a narrow neck or treated surgically. Surgery should, however, be avoided if possible as ordinarily, the patient will be on dual antiplatelet therapy. Hematoma is a common complication associated with arterial access as well as the use of anticoagulant and\u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cb id=\"docs-internal-guid-2088373c-7fff-b5ca-b99d-b39bd6fe534c\">[00:01:00] \u003C\u002Fb>antiplatelet agents or utilized in PCI. They're usually mild and self-limiting but can look fairly alarming to the patient. Very rarely, if extensive in the arm, they can result in compartment syndrome requiring surgical decompression. Most management for hematomas is usually just conservative and includes analgesia, compression if acute or evolving, and rest and elevation of a limb\u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cb id=\"docs-internal-guid-2088373c-7fff-b5ca-b99d-b39bd6fe534c\">[00:01:30]\u003C\u002Fb> if it's the arm that's affected. If severe hematomas are tender, you should consider ultrasound to exclude a pseudoaneurysm. Retroperitoneal hemorrhage is a dangerous complication associated with PCI that can sometimes be difficult to recognize as bleeding into the retroperitoneal space cannot be seen externally. Clinicians should suspect to retroperitoneal hemorrhage if the hemoglobin value falls especially in the context of a post-procedural drop in\u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cb id=\"docs-internal-guid-2088373c-7fff-b5ca-b99d-b39bd6fe534c\">[00:02:00] \u003C\u002Fb>blood pressure. Another sign will be abdominal pain on a straight leg raise examination or Cullen's and Grey Turner signs which usually occur late in the presentation as discoloration or bruising around the umbilicus and abdominal flanks. Early diagnosis of retroperitoneal hemorrhage is imperative. Fluid resuscitation should be initiated as soon as possible for circulatory support and emergency CT\u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cb id=\"docs-internal-guid-2088373c-7fff-b5ca-b99d-b39bd6fe534c\">[00:02:30] \u003C\u002Fb>scanning of the abdomen should be obtained if there is concern of retroperitoneal hemorrhage to confirm the diagnosis. Manual compression of the bleeding site may help if the femoral vessels are easily compressible and the hemorrhage may require emergency blood transfusion, reversal of anticoagulation, and even interventional radiology to stent or open vascular surgical repair. Distal embolization may occur as a consequence of instrumentation of\u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cb id=\"docs-internal-guid-2088373c-7fff-b5ca-b99d-b39bd6fe534c\">[00:03:00] \u003C\u002Fb>the aorta. Introduction of instruments into the aorta may cause cholesterol embolization from existing plaques. This embolization can involve peripheries and also renal and other endoorgans which may present with organ-specific findings such as renal impairment. After performing a PCI, it's important to monitor patients for clinical and vital signs that indicate bleeding due to arterial access complications.\u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cb id=\"docs-internal-guid-2088373c-7fff-b5ca-b99d-b39bd6fe534c\">[00:03:30] \u003C\u002Fb>Remember, you have to think about retroperitoneal hemorrhage if the patient is shocked with no obvious external bleeding since it can often be occult. Other complications of arterial access and instrumentation of the aorta include distal embolization or renal injury.\u003C\u002Fp>",{"courses":245,"showAwardsBelow":48},[246],{"id":247,"isFreeCmeCourse":248,"title":249,"type":250,"specialization":251,"teachers":253,"cmeCredits":255,"teacherIllustration":256,"backgroundImage":257,"relativeUrl":258,"lastChanged":259,"created":260,"description":261,"relativeURL":258,"meta":262},6225,false,"Percutaneous Coronary Intervention Essentials","course",[252],"Cardiology",[254],"David G O’Brien, MD FRCP",6,"https:\u002F\u002Fmedmastery-backend-prod-kjbeds.s3.eu-west-1.amazonaws.com\u002Fmedia\u002Fimages\u002F99f55ee2-c18c-46fb-97fa-c3870c926ac5","https:\u002F\u002Fmedmastery-backend-prod-kjbeds.s3.eu-west-1.amazonaws.com\u002Fmedia\u002Fimages\u002F99f55ee3-6401-420b-86b0-ea0adf25dab5","\u002Fcourses\u002Fpercutaneous-coronary-intervention-essentials","1763556345","1558283528","Perform your own percutaneous coronary interventions (PCI) with this step-by-step course. 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This course will debunk common myths surrounding PCI patient selection so you can offer it to more patients who need it.",{"duration":263,"quizzes":264,"lessons":265},15477,8,55,{"id":267,"name":254,"image":268,"profession":269,"relativeUrl":272,"specializations":273},2550,"https:\u002F\u002Fmedmastery-backend-prod-kjbeds.s3.eu-west-1.amazonaws.com\u002Fmedia\u002Fimages\u002F9c43cefe-fe4e-432c-9c46-803dfb2b5a31",{"name":270,"description":271},"Cardiologist","David is a Consultant Interventional Cardiologist and Clinical Director of Cardiology at the Lincolnshire Heart Centre in the UK, and is a passionate teacher.","\u002Fteachers\u002Fdavid-g-obrien-md-frcp",[252],127,"3m",[277,304,323],{"id":278,"title":279,"text":280,"image":281,"author":289,"path":298,"readDuration":299,"readDurationFormatted":275,"internal":300},1350,"How to Recognize INOCA (ANOCA) on an Exercise Stress Test ","Angina, abnormal stress test, clean coronaries—that's INOCA (or ANOCA), and it carries real risk. 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He is an internist with a specialization in cardiology and a master’s in public health from Johns Hopkins University.",{"name":296},"Internist",4,"\u002Fmagazine\u002Fexercise-stress-ecg-inoca",141,{"created":301,"updated":302,"published":303},1778115738,1778118425,1778118255,{"id":305,"title":306,"text":307,"image":308,"author":314,"path":316,"readDuration":317,"readDurationFormatted":318,"internal":319},1348,"Hyperlipidemia screening: who, when, & what to measure","Testing for hyperlipidemia can help you mitigate your patients' cardiovascular risk. Learn who to screen and when, which measures to request, and how to stratify risk.",{"alt":309,"title":283,"size":310,"location":312},"Lipid panel blood sample tubes used to test for hyperlipidemia in a laboratory setting",{"width":311,"height":311},600,{"bucket":287,"key":313},"\u002F2026-04\u002FC121_magazine image.png",{"id":290,"title":291,"relativeURL":292,"image":293,"professionLong":294,"profession":315,"weight":297},{"name":296},"\u002Fmagazine\u002Ftest-for-hyperlipidemia",246,"5m",{"created":320,"updated":321,"published":322},1777403036,1777572381,1777412421,{"id":324,"title":325,"text":326,"image":327,"author":332,"path":341,"readDuration":342,"readDurationFormatted":343,"internal":344},1347,"Outpatient care for COPD exacerbations","Most acute COPD exacerbations can be managed with outpatient treatment. Learn how to treat mild and moderate COPD exacerbations—and when to escalate care.",{"alt":328,"title":283,"size":329,"location":330},"Older patient using a handheld nebulizer to inhale bronchodilator medication during an acute COPD exacerbation",{"width":311,"height":311},{"bucket":287,"key":331},"\u002F2026-04\u002FC133(4)_ exacerbations_magazine image.png",{"id":333,"title":334,"relativeURL":335,"image":336,"professionLong":337,"profession":338,"weight":340},5365,"Siamak Moayedi, MD","\u002Fteachers\u002Fsiamak-moayedi-md","https:\u002F\u002Fmedmastery-backend-prod-kjbeds.s3.eu-west-1.amazonaws.com\u002Fmedia\u002Fimages\u002F9c43cf02-1064-4074-817b-0eb5de6ded74","Professor and Director of Medical Student Education, University of Maryland and Course Director, Essential and Critical Procedures, Emergency Medicine.",{"name":339},"Emergency medicine physician",1533,"\u002Fmagazine\u002Facute-copd-exacerbation-treatment",191,"4m",{"created":345,"updated":346,"published":347},1776705362,1776710540,1776710541,{"seo":349,"og":351},{"title":350,"description":213},"PCI—arterial access complications  | Medmastery",{"title":350,"description":213,"image":352},{"alt":283,"title":283,"size":353,"location":356},{"width":354,"height":355},652,317,{"bucket":287,"key":357},"\u002Fmigrated-images\u002FScreen Shot 2019-09-09 at 1.10.47 pm.png",{"id":359,"created":360,"updated":361,"published":360},307,1560940873,1655879244]