One of the most intense experiences of my cardiovascular rotation was witnessing a 3 x CABG in the OR. Not only did I get to observe the surgery, the anesthesiologist and technician discussed the medications used throughout the procedure. Maintaining tight control of blood pressure, glucose, pH and anticoagulation throughout the process was essential in sustaining hemodynamic stability of the patient and in supporting the delicate homeostasis of vital organs including the brain and kidneys. Medications do not get their fair share of the glory in open-heart surgery but the use of the “heart and lung” machine would not be possible without heparin. This machine is incredible as it minimizes blood loss, controls blood flow and provides an easily accessible source of blood to measure the specific parameters. Anesthetics, inotropes, vasopressors, neuromuscular blockers are a few of the agents employed to facilitate a successful surgery. Oh yes, and a bag of 100mmol/L KCl (nope, no decimal).
The anesthesiologist explained the various structures we were viewing on the ECHO from different planes, what each of these meant, how this was used to measure valvular regurgitation and how the image may differ in a heart with differing pathophysiologies. Once again this visual brought a new life to the reports on powerchart and broadened my understanding of the imaging.
So where does Cinderella fit in? Well, surgery was delayed (on one of the rare occasions I make plans of course *sigh*) and I had permission to leave at any time but there was no way I would miss this. I was rewarded for my patience by witnessing a heart, slowly come back to life. I learned how the ECHO and direct observation was used to assess the capability of the right ventricle to receive blood as the heart resumed its job of pumping blood to the body. I was left with 30mins to make myself presentable for a formal foodie event and it was so worth it! (this is likely an odd place to mention how very much I enjoy eating appies)
This was my final day of a great cardiovascular rotation and a fantastic day to be in residency!