so this is it, final shift ever on the unit almost over... end of an era. *sniff*

came on shift tonight and as i had expected, balloon pump lady had died. as with most of these cardiology admissions to the unit, they come with blocked arteries with a decision made already by both the physicians and surgeons to leave them blocked, no further intervention being feasible. this lady was no different.

as luck would have it, around midnight, i get a call from the duty cardiology registrar with (surprise surprise) another request for a bed. two beds in fact. another two elderly ladies with unstable myocardial infarcts, both needing ballooning! one was already next door on ccu*, the other en route from a neighbouring dgh* (which usually cannot handle intraaortic balloon pumps on their own coronary units, hence have to transfer out). will this never end?!

so i go next door to take a look... the lady there does indeed need to come over imho, so we got on with that pretty smartish. very large anterior stemi* with pressures dropping to 50. took a while to get an art line in, all her peripheral pulses were thready and i didnt want to take up a femoral in case she needed to go for angio and/or ballooning. finally stuck in a left femoral. took her to cath lab for cardiac reg to site the balloon... was complicated by cannulation of the femoral vein, with subsequent tickling of the ra*/tv* prob, which triggered off a junctional brady and then pea*. got her back with minimal compressions and atropine/adrenaline. just as well we had venous access, as a temporary pacer could rapidly be put in! rhythm stable, balloon finally was placed. started inotropic support and watched her for the rest of the night...

the other lady arrived around 0200, but the cardiac reg managed to avoid a balloon and hold her next door, without needing to come to us overnight. had to step one patient down to the regular ward in the middle of the night to make way for this second admission. kept the bed open for her anyhow, just in case. *phew*

man, whats with all these cardiology admissions! =/

so made it to morning without much hassle, two postops doing ok. what a way to finish this job on, a full workup on one final real sickie, assessed, lined, ballooned and treated in the middle of the night. woohoo! what a way to go! wouldnt have had it any other way i guess. will miss this unit. good bunch of staff, great (for great read spanking brand new state of the art) unit, supportive medical team, one of the best jobs ive worked to date...

start anaesthetics monday. *shudder*

food of the night:

pork dumplings, tea

news:

- so sasser.d has struck the uk coastguard, hospitals in hongkong, the post office in taiwan and banks & railway network in australia since yesterday. only a level 2 threat actually. the earlier sasser.b was far more sinister, at level 4.
- "no stone will be left unturned" from the armed forces minister, on the inquiry into those daily mirror photos of uk soldiers abusing iraqi pows.
- the middle east roadmap has been discussed by the quartet yet again at the un in new york. doesnt look like much had been accomplished (again?). bush still backs sharons partial withdrawal plans, which had actually been rejected already by sharons own likud party. as with all of these things, this will never get anywhere. hmm...

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* ccu = coronary care unit, dgh = district general hospital, stemi = st elevation myocardial infarction, ra = right atrium, tv = tricuspid valve, pea = pulseless electrical activity
posted by Chas at 07:33
go ahead, roll the donut!