In October of last year, I wrote about the importance of becoming a clinician leader. As I have thought more about this topic, I have come to realize that a big part of being a leader is being able to empower others. I have witnessed this first hand after our practice’s recent development of daily, bedside nurse-led, multi-disciplinary rounds. A couple of months ago, as a response to several factors, we started this practice on both our stepdown unit and ICU. First, our patient population, as I am sure everyone else is experiencing, continues to get older and sicker. The amount of details that need to be kept straight on two large, busy units continues to grow. Second, more than ever, we are being held responsible for complications like central line and in-dwelling foley catheter infections, as well as statistics like extubation time, and length of stay. Finding an additional way to review all of these details has become paramount. Finally, we wanted to ensure that we could still provide the same level of care to our patients regardless of nurse turnover, or the addition of less experienced APPs.
CT Assist Blog
Pulmonary hypertension (PH) is a complicated, and potentially life threatening, disease that is defined as having a mean pulmonary artery pressure greater than or equal to 25 mm Hg at rest. It was first described in medical literature in 1891 by a German physician, Ernst von Romberg, who mentioned pulmonary vascular stenosis in an autopsy. While it is considered a rare disease, being seen in only 1-2 people out of every million across the United States and Europe, those of us practicing cardiac surgery at programs with advanced heart and lung failure patients will likely see a lot of this disease.
I’m not the chief. It’s not my problem. No one cares what I think, or how I act. We have likely all heard or thought these words a million times. I can’t say that I haven’t thought them myself. I’ve written about the importance of functioning as a team in the past, and a large part of that comes from each member looking out, not only for him or herself, but for the team as a whole.
Topics: CT Surgery
In my years practicing as a cardiac surgery PA, I have only come across two patients with Takotsubo cardiomyopathy (TTC). Perhaps large teaching centers have higher volumes of this type of patient. When I came across my most recent patient, I was reminded that it is a fascinating, if not terrifying, disease process. Here is a brief review of the epidemiology, causes and clinical presentation, and outcomes after diagnosis. I have also included a few articles I found useful or reference.
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.