Perfusion Notes: [5]

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Getting My Feet Wet:

Well I am finally getting into the meat of my program.  I have already seen a rather diverse case load.  I would say the coolest thing I have seen so far is a heart transplant.  I had seen a lot of cases while I was shadowing, but a transplant was new.  It is a pretty awesome and powerful thing to see.  I even went and stood next to the anesthesiologist and looked down.  I find it absolutely incredible that technology is advanced enough that when I look down there is just a huge crater in the chest and the donor heart sitting on the surgical table in a basin.  The case went pretty smoothly as well, so I could spend a lot of time watching the procedure instead of observing the perfusionist.  This brings me to my first point.

The more and more I get into the didactics and observations I realize how small the percentage is that represents running the machine.  All of this education is designed to teach me why I am making alterations on the machine and how to use different drug therapies to maximize the patients status.  This is made clear mainly by talking with the perfusion instructors during surgery.  They teach very little about what they are actually doing, but teach why they are doing it.  Just saying I turned the Fi02 up because this number was low on CDI is not what they do.  Most of the time they will say watch this and point to part of the CDI for me to watch and as it rises they explain what they are doing and how it is affecting the patient.

I really have not had any problems with staff or classmates.  However, we have only known eachother for awhile now and of course little flare ups happen.  It has been made pretty clear the word perfusionist is synonomous with a Type A person for the most part.  My touch of OCD is helping stay organized with time management, reading assignments and hours in the operating room.  I will say the reading is more strenuous than I thought it would be.  I mean I understood there was going to be a lot of reading.  However, usually I read something once and it clicks right away and is locked in to my brain from there, but with some topics I find myself reading and rereading the same paragraph several times until it clicks or someone explains it to where I understand it.  This has helped with deep memorization though, because after working at trying to understand something you sure don’t forget it.

The facility I am at is pretty nice.  We do not have the newest or oldest equipment.  The cost is always on the minds of everyone and the protocols reflect the fact that cost efficiency is important.  Our heart lung machines do not have all the different bells and whistles that they could have, but are sufficient and smaller than a lot of machines.  That is one of the surprises I ran in to.  The OR’s here are much smaller than what I am used to.  When we are setting up and getting things ready for a case we barely have a crack inbetween the heart lung machine and the wall.  The rooms were clearly not designed for this type of machinery to be used in it when it was originally designed.  However, it works out fine, especially once you pass the lines up and have moved the machine up to the table there is plenty of room too work and is not a problem.  As for the surgeons, I have only had the opportunity to watch three different ones work.  One is an old school surgeon and to put it lightly he is good at what he does.  As in good enough that if I had an MI tomorrow I would have him cut on me.  He may not use the newest tools and little gizmos the younger guys use, but he is a very skilled surgeon.  The other 2 are also very good, they are younger and a little more with the technology movement and use the newer stuff.

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A Tough, Tough Case…

Well while I’m sitting here typing I take back what I said about the heart transplant being the coolest thing I have seen.  Yeah, that is pretty awesome to see, but the coolest thing I have seen started as a MVR with a MAZE.  It was going just fine until we tried to come off pump and then started bleeding everywhere.  The patient suffered AV Dissociation.  The older surgeon that I was discussing being amazing was the surgeon involved.  He tried everything, we were in there for somewhere around 8-10 hours, can’t remember exactly.  At one point he said he has done everything he could and walked out and waited for us to rewarm.  When he scrubbed back in he told us that this was going to be our last try coming off and there was nothing else to do if the patient was still uncontrollably bleeding.  So he does his thing up at the table and we start to come off bypass when the amazing happened.  Normal sinus rythm came back by itself and the patient came off bypass about as good as possible.  It was truly amazing.  Now I have not checked to see how the patient has done, but was incredible watching a surgery like that.

I am really enjoying the program so far and actually look forward to each new day still.  Some of the instructors let us do more than others, but for the most part they are letting us go on, run the pump and come off pump while they talk us through it.  Obviously we have a lot to learn, but starting to practice running the pump only make me think that I will be very ready to run the pump solo by graduation.

Anyways,  I will write another entry over the next 2 weeks and hopefully will have some more good material to talk about.

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