Maintaining order on a busy cardiac surgery service can be a daunting task. If you work in a practice where there are several surgeons and advance practice providers, every person is going to have a different idea about how to care for patients. It is true that there are many ways to treat a patient after cardiac surgery, and no medical problem can be solved with a cookie cutter approach. This being said, having a practice manual filled with guidelines can ensure that all patients are getting consistent care, provide new hires with an additional resource, and allow for the surgeons’ vision of how they want patients cared for to be realized without him or her always having direct patient contact.
CT Assist Blog
Topics: Cardiac Surgery
As the years go by, I feel like I’ve become better equipped to handle any situation I face at work. I’m not saying I always know exactly what to do, but the experience I have obtained over the years has given me a large tool box to work from. I can usually get out of any situation with a minimal amount stress. Unfortunately, this same principle does not apply to vein harvesting. The bad veins always find me. I have a running joke at work that I can create drama in any vein harvesting situation. Don’t get me wrong; I always find a way to get the vein out, and rarely will it need any repairs. But sometimes I think it takes years off of my life. As I sat and thought about this I realized that difficult veins have given me a tool box for vein harvesting too. Experienced harvesters will have heard these tips before, but for any new comers to EVH, I thought I’d share a few of the tools that have helped me along the way.
CT Surgery Physician Assistants are the workhorses for most CT Surgery programs across the nation. There are dwindling numbers of experienced CT surgery Physician Assistants with the skill-sets required to effectively manage the high acuity patients. General Surgery residents are leaving CT Surgery in droves to maintain their strict 80 hour work week. CT Surgery PAs are leaving the jobs they love to pursue a better life in a less demanding specialty. There exists a shortage of CT Surgeons, and the problem will likely worsen. Hospitals are asking for more than ever from their CT Surgery physician assistants, putting their PAs at risk of burnout.
Topics: Physician Assistant Burnout
Topics: Nailbed lacerations
Diffuse idiopathic skeletal hyperostosis (DISH) is an idiopathic disease characterized by osteophyte formation in the spine. Patience with DISH has confluent ossifications spanning 3 or more intervertebral disc spaces. This occurs most commonly in the thoracic and thoracolumbar spine. The bridging osteophytes follow the course of the anterior longitudinal ligaments and the peripheral disc margins. DISH primarily affects men more than women and occurs in those 60 years of age and older.
I remember when I first started working in the ICU, and I had to get my first patient off the ventilator. I thought, I have no idea how to do this. Luckily, in that case, I had an experienced ICU nurse who helped me. Getting the standard postoperative patient off the ventilator is now second nature, but I was recently talking to a newer colleague about how to do it, and I realized that a brief review might be helpful for any PA or NP new to the cardiac critical care setting.
Topics: Cardiac Surgery
Any mid-level practitioner who is responsible for running codes in the postoperative cardiac surgery population knows that there are a lot of moving parts in these scenarios. There are a lot of people to keep track of, and a lot of jobs to do in a short amount of time. Practice and experience keep mistakes to a minimum which, hopefully, produces a positive outcome. Unfortunately, I have been in several code situations where, even though we did everything right, there was still a less than favorable outcome. What I'm referring to are situations where ACLS guidelines have been applied, but have failed. For example, you pushed a milligram of epinephrine in a code, and your patient’s blood pressure went to three hundred mmHg, requiring a return to the operating room for bleeding. Perhaps your staff was doing appropriate CPR, hard and fast just like they teach it, and a saphenous vein graft was ripped off the heart, or an aortic suture line ruptured. I've even seen CPR cause a patient’s sternum to cut into his ventricle and cause catastrophic bleeding.