I was reminded last night while texting my perfusion bud- Whitt, that the idea of expecting new grads to have mastered the art of setting up monitoring lines, Swanz-Gannz, etc; and be more or less ready to troubleshoot monitoring systems, was “Old School”. Bummer for me 🙁
I then asked if being able to calculate SVR was perquisite for our clinical “game” and he did manage to concede that yeah- it kind-of was germane to what we do. These two items came up for discussion recently during my brief stay at one of the Midwest Hospitals I visit now and then, especially when noting that my junior colleague was flowing @ 7 LPM with a MAP of 50ish. I won’t go into the details of the back and forth- although we did laugh a bit- and engaged in some mental jousting consistent with two people that like each other, but have never worked together, and trying to establish a baseline of clinical awareness blah blah blah. It’s kind of a meet-and-greet predicated on respect for the 3 letters above- “CCP”, what it confers in terms of license to practice, and more importantly, what it denotes in terms of professional respect/expectations. It wasn’t a “I know more than you know” sort of encounter, rather two people learning how to function as a team together.
My colleague pumped this case and post bypass, I was feet up on the desk in the perfusion office, chilling and texting to whomever about whatever. Got a quick wake up call from said colleague informing me that our patient was crashing, MAP was 30, and chest compressions were being delivered. Bummer for me 🙁
Well, the pump was still set up, water lines off, vacuum assist needed to be addressed as my venous line at the table was drained and empty. There is something to be said about teamwork here. It was my colleagues case, but in theory I was “the guy” due to experience as well as familiarity at this site. We switched roles seamlessly- without needing to articulate it, and at first I needed to adjust due to the fact that we all set up our pumps a little differently, different priorities, and so forth. To put it mildly- there was no need to calculate an SVR, and we got on bypass seamlessly, fixed the issue at hand and came off a couple hours later. During this time, it became clear to me that perfusion really isn’t just what we know or have studied, and requires more than quick calculations or rote memorized data. The intangibles aren’t written in a text book, they emerge with action, teamwork, and an obvious desire to take care of the patient at hand. That was 3 hours of witnessing what we are bred for, and I’m pretty sure that mastering arterial line setups will be a cakewalk. I’ll take dedication and effort over arterial line setups anytime.
Well done. “That’ll do Pig, That’ll do…” 🙂