Practical procedures in cardiology

Contemporary cardiology is highly invasive, often adopting early interventional treatment strategies for prognostic advantage. Proactively managed patients are often unstable and require early invasive monitoring and treatment. It is therefore more important than ever that the emergency physician responsible for the initial phase of patient stabilization is highly competent in the practical bedside procedures which are necessary in the critical care setting. This article summarizes four common procedures: central venous access, temporary cardiac pacing, pericardiocentesis and the use of the intra-aortic balloon pump. Basicprincipals and indications are outlined, but the emphasis is on the practical and procedural detail. Many common themes (such as aseptic technique) run through all four procedures and complications can be similar. An appreciation of potential complications can improve operator competence and allow their early identification and management.