When did you learn how to harvest vein?
CT Assist Blog
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.
Your patient has made it out of the operating room, and you have succeeded in stabilizing him or her. Perhaps you were able to wean the patient from the ventilator quickly, or maybe the patient was in cardiogenic shock for weeks. Regardless of how the journey started the sign out is that your patient is now ready to transition to step down status, and it's your job to determine if he or she is ready.
The holiday season is upon us and, for once, patients actually want to be sent home from the hospital. This is not usually the case. Most of the time, my patients do not want to be discharged. I am sure it’s because they are scared and anxious. They receive pages of instructions regarding what medicines they should take, what appointments they should make, what they should do, what they shouldn’t do, and who to call if there is a problem. They are expected to make sense of all of this while being in a strange environment where they have not slept well, and where they are being given narcotics that cloud their senses.