#Cardiac surgical procedures

[unitedhospital]

Things to Keep in Mind While Choosing the Right Cardiac Surgeon

There is nothing more worrisome than discovering you have a heart issue. It's no secret that acting promptly is crucial, especially with cardiac problems that can quickly become serious. Fortunately, today, advanced technology and expert cardiologists make high-quality cardiac care easily accessible when it's most needed.

However, according to cardiac specialists at United Hospital, recognized as the Best Cardiology Hospital in Bangalore, say that finding the right cardiac surgeon for you is quite a challenge

Here are some important factors you can keep in mind.

Choosing the Best Cardiac Surgeon

According to Bangalore’s Best Cardiologist operating at United Hospital, the skill sets Of your operating surgeon play a huge role especially when complicated cardiac surgeries are to be performed. Therefore, it's crucial to choose your cardiac surgeon wisely.

ReferralsSeeking recommendations from your friends, family and other healthcare professionals can be very useful while searching for a professional cardiac surgeon. Though you have a reference, assess your surgeon by communicating with him freely.

Review his credentialsAs the patient in question, you have every right to study your cardiac surgeon’s credentials with respect to his qualifications and certifications. It is a good choice to connect with hospitals whom your surgeon is associated with and study his records.

Consider the Surgeon’s experienceSuccess percentages of the surgeon are of paramount importance when deciding on engaging a cardiac surgeon. The more experience with a particular condition or procedure a cardiac surgeon has, the better your results are likely to be. If possible, get in touch with patients whom the surgeon in question has treated to understand his approach.

Research Hospital QualityChoose a hospital which has all the advanced surgical facilities and more importantly, rehabilitation facilities as the duration of your hospital stay after surgery depends upon how quickly you respond to treatment post-surgery. Hence, choose a hospital which has a good track record for cardiac care as well as convenient to travel for frequent checkups.

CommunicationCommunication Skills and Confidence levels of your surgeon are equally important. It is good to engage a surgeon who can communicate freely and instil confidence in you especially if the surgery is tricky and communicated. At the same time, he should be able to understand if you have any budget constraints and suggest the best possible approach which does not deprive you of quality treatment.

Cardiac surgeries can be stressful for patients and their loved ones. Therefore, choosing a hospital and surgeon who makes you feel comfortable from the beginning is essential. If you're seeking a Good Heart Hospital in Bangalore with an experienced cardiac team, consider reaching out to United Hospital.

[mercuryhc2024]

Choosing the Right Sternum Saw: Key Features and Best Practices for Surgeons 

Selecting the right sternum saw is crucial for ensuring successful surgical outcomes, particularly in complex cardiac and thoracic surgeries. As the largest and most trusted manufacturer, supplier, and exporter of sternum saws worldwide, Mercury Healthcare is at the forefront of innovation, providing high-quality surgical tools that meet the needs of modern healthcare professionals. In this article, we explore the key features surgeons should consider when choosing a sternum saw and why Mercury Healthcare is the preferred choice for healthcare providers globally. 

Key Features to Look for in a Sternum Saw 

Precision and Control In critical surgeries, precise cutting is essential to minimize trauma and ensure patient safety. A sternum saw must offer excellent control, allowing surgeons to perform procedures with accuracy. Mercury Healthcare's S1 Sternum Saw is designed with a clear line of sight and lightweight construction, providing surgeons with exceptional control during surgeries. The precision of our saws ensures efficient cutting, reducing the risk of complications and enhancing patient recovery times. 

Ergonomics and Lightweight Design Long surgical procedures can be physically demanding for surgeons. A well-designed sternum saw should be lightweight and ergonomically crafted to reduce hand fatigue and allow surgeons to operate comfortably for extended periods. Mercury Healthcare prioritizes surgeon comfort, and our sternum saws are built with a balanced, lightweight design that enhances both maneuverability and ease of use. 

Sterilization Compatibility Fast and efficient sterilization is crucial in surgical settings to prevent infections. Our S1 Sternum Saw can be ETO sterilized or autoclaved, ensuring a quick turnaround between procedures. This feature is especially beneficial in busy operating rooms where time is critical, helping medical teams maintain optimal cleanliness without sacrificing efficiency. 

Convenience and Safety Features Safety features are a must for any surgical instrument. Mercury Healthcare's sternum saws are equipped with quick-release blades and a patented retention system, making blade changes seamless and reducing downtime during operations. Additionally, the tapered blade protector helps deflect underlying tissues from contact with the blade, minimizing the risk of tissue damage during surgery. These features make our saws both convenient and safe, allowing surgeons to focus on what matters most — patient care. 

Durability and Reliability A reliable sternum saw must withstand the demands of frequent use in high-stakes surgical environments. Mercury Healthcare's sternum saws are made from high-grade materials that ensure durability and longevity. Whether performing routine procedures or complex surgeries, our saws provide consistent performance, making them the trusted choice for surgeons worldwide. 

Best Practices for Using a Sternum Saw 

To maximize the performance of a sternum saw, surgeons should follow these best practices: 

Regular Maintenance: Proper cleaning and maintenance after each use will ensure the saw's longevity and precision. 

Blade Replacement: Always use sharp, sterile blades, and replace them as necessary to avoid unnecessary pressure on the sternum. 

Operator Training: Surgeons and surgical teams should undergo proper training to ensure the correct and safe use of the sternum saw, reducing risks and improving surgical outcomes. 

Why Choose Mercury Healthcare? 

At Mercury Healthcare, we are committed to delivering high-quality, innovative surgical equipment that meets the demands of healthcare professionals around the globe. As the leading manufacturer and exporter of sternum saws, we combine cutting-edge technology with a deep understanding of surgical needs. Our focus on precision, safety, and reliability has earned us the trust of surgeons worldwide, making Mercury Healthcare the go-to provider for advanced medical tools. 

Our sternum saws are not only built for superior performance but also designed with the future of healthcare in mind. As we continue to innovate and set new industry standards, we remain dedicated to improving patient outcomes and enhancing the surgical experience for healthcare providers. 

[eirenical]

Here's the updated map for June 7, 2023 7:00 AM:

If you are on the East Coast and trying to figure out what all of these air quality warnings mean and what you should do, here is what the colors and corresponding AQI numbers mean. The updated AirNow map is at this link:

Edit: this was posted at 10:50am on June 6 2023 and the screenshots were taken around 9am.

[med-fetish]

Hello! Today I started playing with AI, this is what I came up with, I hope you enjoy it !

Isabelle was 26 years old when her life took an unexpected turn. Since childhood, she had always been an active and energetic woman. She loved running in the park, practicing yoga, and spending hours exploring the city with her friends. But everything changed one summer day when she began to feel a persistent pain in her right side. At first, she thought it was just a muscle strain, a consequence of her busy schedule and long hours at the gym.

However, the pain did not go away. After several medical consultations and tests, she received a devastating diagnosis: kidney cancer. The news hit her with overwhelming force. The idea of facing such a serious illness at her age was terrifying. Despite the tears and anguish, Isabelle gathered her courage and prepared for what lay ahead. She knew she had to undergo surgery to remove the affected kidney.

On the day of the operation, Isabelle arrived at the hospital with a mix of nerves and hope. She was greeted by a medical team that reassured her and prepared her for the procedure. In a private cubicle, she changed into a surgical gown, feeling the cold fabric against her skin. Clara, a kind nurse, placed a hair cap on her head and explained the importance of the compression stockings, which were put on her to aid circulation during the surgery. Despite her discomfort, Isabelle felt a bit more at ease.

When it was time for anesthesia, Dr. Martínez placed an intravenous line and explained that she would feel a little dizzy. As the medication took effect, Isabelle felt the world slowly fade away, leaving behind her worries. However, what no one expected was that the surgery would become complicated.

Hours passed, and the medical team realized that something was wrong. As the operation dragged on, a growing fear filled the operating room. Suddenly, alarms began to sound. Isabelle had gone into cardiac arrest. “She’s going into arrest!” shouted a nurse. In an instant, the room became a whirlwind of activity.

Dr. López, the lead surgeon, moved quickly, directing the team with precision. Dr. Martínez adjusted the anesthesia and administered emergency medications. Every second counted as the team fought to stabilize her. After several attempts, they finally managed to restore her pulse. The operating room, once filled with tension, was flooded with a sigh of relief.

With Isabelle’s heart beating again, the team continued the surgery, this time with renewed determination. Finally, after hours of hard work, Dr. López announced that they had finished. Isabelle was transferred to the recovery room, where she began to awaken. Her body felt heavy and confused, but the sound of the monitors reminded her that she had overcome a great battle.

As she regained consciousness, she found herself in a calm silence. When she opened her eyes, she saw a nurse approaching, who explained what had happened and assured her that she was okay. Over time, Isabelle began to understand what she had experienced. Although she had faced an overwhelming challenge, she had come through it.

Her recovery was a gradual process. With each passing day, her strength returned, along with her determination to live fully. She joined support groups, shared her experience on social media, and became a health advocate. Her story resonated with others facing similar situations, inspiring them to keep fighting.

A year after the surgery, Isabelle signed up for a charity 5K run, a goal she had set for herself before her diagnosis. On the morning of the race, she felt a mix of emotions. As she ran, each step reminded her of her struggle and the life she had regained. Crossing the finish line brought tears to her eyes, but this time they were tears of joy and gratitude. She had faced her fear and emerged victorious.

Isabelle had not only survived an illness; she had learned to live again, with a new perspective and a deep appreciation for each day. Her story became a testament to resilience, reminding others that even in the darkest moments, there is always a light at the end of the tunnel.

[literaryvein-reblogs]

Some Cardiology Vocabulary

for your next poem/story

Ablation – Elimination or removal.

Annulus – The ring around a heart valve where the valve leaflet merges with the heart muscle.

Arrhythmia – (or dysrhythmia) An abnormal heartbeat.

Autologous – Relating to self. For example, autologous stem cells are those taken from the patient’s own body.

Bruit – A sound made in the blood vessels resulting from turbulence, perhaps because of a buildup of plaque or damage to the vessels.

Cardiac – Pertaining to the heart.

Cardiomegaly – An enlarged heart. It is usually a sign of an underlying problem, such as high blood pressure, heart valve problems, or cardiomyopathy.

Carotid artery – A major artery (right and left) in the neck supplying blood to the brain.

Claudication – A tiredness or pain in the arms and legs caused by an inadequate supply of oxygen to the muscles, usually due to narrowed arteries or peripheral arterial disease (PAD).

Commissurotomy -A procedure used to widen the opening of a heart valve that has been narrowed by scar tissue.

Digitalis – A medicine made from the leaves of the foxglove plant. Digitalis is used to treat congestive heart failure (CHF) and heart rhythm problems (arrhythmias).

Endocardium – The smooth membrane covering the inside of the heart. The innermost lining of the heart.

Infarct – The area of heart tissue permanently damaged by an inadequate supply of oxygen.

Jugular veins – The veins that carry blood back from the head to the heart.

Maze surgery – A type of heart surgery that is used to treat chronic atrial fibrillation by creating a surgical “maze” of new electrical pathways to let electrical impulses travel easily through the heart. Also called the Maze procedure.

Myocardium – The muscular wall of the heart. It contracts to pump blood out of the heart and then relaxes as the heart refills with returning blood.

Palpitation – An uncomfortable feeling within the chest caused by an irregular heartbeat.

Pericardium – The outer fibrous sac that surrounds the heart.

Regurgitation – Backward flow of blood through a defective heart valve.

Septal defect – A hole in the wall of the heart separating the atria or in the wall of the heart separating the ventricles.

Sources: 1 2 3 4 ⚜ More: Word Lists

[orionremastered]

Ok but just imagine :

Surgeon!Damian Wayne and Surgical intern/resident!reader. Or the reader could be an attending idk? But it’s so enemies to lovers coded! The tension??!???!!!!! Damian is the scary attending and the reader doesn’t dower like the rest? Or the reader is sunshine and the complete opposite of Damian’s personality. It’s a very scrambled idea but I just thought you might like to work with it?

Enemies to lovers? sign me tf up

Also, istg I had no idea what a surgical resident was before this. For those who don't know, they spend about five-ish years in a hospital and are usually under direct supervision of a more senior resident or an attending surgeon, attending for short.

Masterlist

Surgeon!Damian Wayne x Surgical Resident!reader

Part One, Part Two

You’re not stressed, you’re just… very close to breaking down. Or breaking a law. Or breaking someone’s nose “accidentally”. Or breaking… it didn’t matter what you broke, you just needed to break it.

Two years in to your internship at Gotham General hospital and you couldn’t be more of a wreck. In the bathroom stall no less- getting yelled at by the chief resident after not knowing what some extremely rare condition was (he didn’t even know it himself) and getting called one or two slurs by a senior resident wasn’t something you were used to and yet you knew it was normal.

Taking in a deep breath, you exit the stall and wash your hands and face before making your way to the OR, muttering positive phrases in your mind that were not helping at all.

With one more nod to yourself for reassurance, you open the door and are immediately greeted by the one face you didn’t want to see.

Dr. Wayne had a very prominent reputation for being less than friendly, for giving any resident- no matter how experienced- mental breakdowns and most importantly for being one of the best cardiac surgeons in Gotham. You exchange a nervous glance with another second-year resident, but only for as long as you dared.

Somehow, you were walking on eggshells without even taking a step.

The patient required a maze procedure, where the surgeon creates a pattern of scar tissue that allows the heart’s rhythm to return to normal.

You try sneaking a glance or two to the attending surgeon, but he glares back at you in warning before you can deduce his mood. Although that was probably a good tell.

The patient finally drifts off to sleep, you shift your attention right back to the attending as he begins the procedure with an incision on the patient’s chest.

Two hours later and maybe a bit too much yelling, the surgery was complete. The other residents begin leaving, but Dr. Wayne stays. You’re about to leave too when a low voice fills the silent space.

“That was the District Attorney,” Dr. Wayne says, and you pause all thought. You did everything right, didn’t you? You didn’t really do much, honestly, but what you did was correct, right? “And I can’t have a day-one intern screw up and jeopardize his health. He’s had a heart surgery before.”

“Do you want me to-”

“Yes,” he snaps.

“What do I tell the-”

“Chief resident? Tell him it’s not his problem.”

You nod and awkwardly leave the OR as fast as possible, not risking another moment in the same room as the man who is known for biting people’s heads off. Not literally.

You hope.

Not wanting to take any chances with the attending surgeon, you manage to find a space just near the DA’s ward that allows you to do paperwork while also being able to easily see the patient every five or ten minutes.

It went on like this for an hour and a half without problem and a snack in between before you exited the DA’s ward yet again, only this time loud and angry steps echoed through the hallway.

Your head whips around and your heart immediately drops to your feet. Your blood runs cold as the chief resident storms down the hall, eyes deadset on you.

You open the door to his office and politely gesture for him to walk inside. The chief resident, Langley, stops, glares and despite his temper, he agrees. You follow him in and swallow nervously, heart pounding in your ears.

“Before you get mad-”

“I already am mad,” Langley seethes, slamming his meaty hand on the small desk. “You abandoned all of your duties to- to what, to suck up to the District Attorney?”

“No sir-”

“Other patients need care and we’re already short on staff without some fucking idiot thinking that they can do whatever the fuck they want-”

“Dr. Wayne specifically requested me to do post-operation patient care-”

Your voices had risen to the point of shouting. You wouldn’t be surprised if the DA could hear it or even the other staff in the nearby wards and hallways.

“He doesn’t need a FUCKING NANNY.” the chief resident cried, and in one swift movement, he grabs a binder and slams it into the side of your face. “And who gives a fuck what that stuck-up WAYNE SURGEON wants?”

“Who gives a fuck on what I want?” a calmer, lower and yet far more terrifying voice states behind you. The hairs on the back of your neck raise and Langley’s eyes go wide. “Certainly not you. And here’s the thing, Langley,” the surgeon moves you aside in the already crowded space, more gently than you expected as he steps towards the chief resident, broad shoulders blocking your view, “that’s a problem. I could have your future ruined with a simple phone call or complaint and you decide to simply not respect authority?”

“That bitch-”

“Did exactly what I wanted her to,” Dr. Wayne replies in the same condescending tone. “Maybe you could learn a thing or two.”

Silence, apart from Langley’s ragged breathing. The ear that was hit rings loudly and when you softly touch you cheek, you can feel a bruise forming.

“You won’t apologize? That’s fine,” the surgeon says with an innocent shrug. “Consider your career gone.”

You certainly weren’t expecting that, and neither did Langley. He sputters in an attempt to right the course of a train that’s already fallen off the cliff, his eyes no doubt as wide as his steadily shrinking ego.

Was Dr. Wayne serious? You were confident that he could ruin someone’s career in a single phone call- he’s the best cardiac surgeon in the state, maybe even the country, and a Wayne, for crying out loud- but would he really just ruin someone’s career so quickly?

“You can show yourself out, by the way.” The surgeon raises an arm in a mocking gesture, beckoning the chief resident to leave and never return. “Security can, too.”

With no options left, Langley huffs and pushes past Dr. Wayne. You can still hear his angry footsteps, like a stampede of bison, as he storms down the hall.

“Thank you,” you murmur to the surgeon as he slowly turns around, inspecting the blow you took by carefully holding your chin and jaw in his large hands. You couldn’t tell if your heart was beating faster when Langley started ripping into you or right now, in this very moment, when you’re forced to stare in to green eyes so close you can make out every speck of dark gold within them.

“Don’t worry about it.” You swear on God’s good graces that the man smiled, just a twitch of his lips. “And please, call me Damian.”

With that, he lets go of your jaw and exits your makeshift office, leaving you flustered and confused.

He wanted you to call him by his first name?

[killed-by-choice]

“Dottie Roe,” 30 (USA 1965)

“Dottie” was a New Yorker seeking medical attention because she had started bleeding in the second trimester. She had suffered two miscarriages in the past and likely feared that she might lose this baby too. Unfortunately, the doctor’s dubious course of action would end her baby’s life and her own.

The medical journal that recorded Dottie’s case does not specify what the diagnosis was, but the doctor decided to put Dottie through a hysterotomy abortion and a tubal ligation. This was a questionable course of action considering that hysterotomy abortion is associated with a very high maternal mortality rate. But since it qualified under the health exemption (“life of the mother” exception), it was completely legal.

The report of Dottie’s death raises questions. She was under general anesthesia for the abortion and tubal ligation, but would never wake up. The journal states that “Cardiac arrest ensued during the procedure, and the patient expired following completion of a tubal ligation, never having regained consciousness.”

Later research found that the risk of hysterotomy abortion concurrent with surgical sterilization was unjustified even in someone perfectly healthy. Today, medical knowledge has advanced beyond the antiquated approach of abortion for pregnancy complications— the recommendation that failed Dottie and her child.

Other pre-Roe legal abortions that were meant as “life/health of the mother” exceptions and killed the patient instead include:

“Carolyn” and “Caroline Roe”: Both died in North Carolina in 1970 or 1971 after abortions for “health indications”

“Bonnie Roe”: Put through an abortion because her heart condition, then died because of drugs for the abortion that were contraindicated in heart patients

“Molly Roe”: Her killers were rebuked by a maternal health committee for a saline abortion that was more dangerous to the young lupus patient than her pregnancy

“Rita Roe”: A cardiac patient who died from multiple pulmonary emboli after an abortion at 12 weeks pregnant

Caro Lena Grasso: An Italian immigrant with a chronic respiratory illness who died of infection caused by the abortion meant to stabilize her

Erika Charlotte Wullschleger: At 28, she was in a tank respirator at Scripps Memorial Hospital. She was just starting to get better before dying from the abortion that her husband, not she, signed the consent forms to.

Barbara Riley: After a doctor told her to have an abortion instead of giving birth again, she reluctantly underwent the highly dangerous saline abortion that took both lives.

(Sources below)

New York State Medical Journal, January 1974

[circadeacademia]

Prompt: Surgery (Escapril Day 28)

Procedure:

Dissection of a desolate cadaver with special focus on the physiological impact of emotional distress

Introduction:

The said procedure aims to explore the anatomical structures of an agonized cadaver with a focus on understanding the physiological manifestations of a heartbreak.

Equipments:

i. A desolate cadaver: A cadaver with a history of chronic heartbreak and acute agony.

ii. Dissection instruments: scalpel (sharpened by an apathetic tongue), scissors (ready to snap at any instant) , forceps (multi functioning i.e grasping truth from the windpipe, retracting false accusations, manipulating sutures of empty consolation), gauze bandages (to fill the void of heart) and other surgical tools.

iii. Dissection table: A sterile table (any empty casket will do) equipped with enough darkness and suffocation particles.

Method:

i. A midline scalp incision was made by the tongue-sharpened scalpel, extending from the forehead to the occipital region.

ii. A craniotomy was performed with high-speed derogatory remarks to create a bone flap in shape of a crushed soul, over the frontal, parietal and temporal lobes.

iii. The dura mater was then incised with utmost neglect to expose the wilting brain tissue.

iv. The brain was then thoroughly laughed at with special attention to the limping limbic system and paranoid prefrontal cortex. Tissue samples were then collected for histological analysis to assess the impact of emotional distress for future guinea pigs.

v. Next, a midline incision was made through the worn sternum using the same scalpel infused with misery.

vi. The torn pericardium curtain was removed to expose the fractured heart.

vii. The heart was then examined for any intact cardiac chambers or other decently performing arteries. The heart was then shattered by the rhythmical hammering of a regular sized taunt.

viii. The heart was then ruthlessly excised in one piece and the cracks were sutured with delusion to put it up for auction.

ix. The cadaver was then abandoned to breathe and walk.

Reflection:

The findings of the following procedure suggest that — active exposure of victim's brain and heart to continuous emotional distress, allows the offender to shape them into malfunctioning masses.

Conclusion:

In conclusion, the following procedure was a success and more such breathing cadavers are currently undergoing the same procedure to ensure the triumph of this groundbreaking surgery.

note: no cadaver was harmed in the following process, all mentioned criteria and procedures are a work of fiction.

— circadeacademia

[kk095]

Christine’s Malpractice Case

Every year, there are thousands of medical malpractice cases reported in the United States. Ranging from surgical or procedural errors, to misdiagnosis, to anesthesia errors, and many other possible factors not listed. We all have a certain level of trust in medical professionals because of their many years of training and education. However, these professionals are people too, and are prone to making mistakes from time to time. Unfortunately when medical professionals make a mistake, it can have major consequences for their patient- leading to further injury, disability, or even death. Sadly, one such case took place at our hospital recently.

The patient was Christine Rossi. She was 47 years old and stood at only 5 feet tall, but her big personality made up for her lack of height. She had a pleasantly plump figure, beautiful brown eyes, shoulder length brown hair, was olive skinned since she was of Italian descent, and always had a fresh mani+pedi. She looked good for her age since she never had kids, and she was never married- but definitely married to her career as a medical malpractice attorney.

Christine’s case began when she was brought into our emergency department one evening straight from her office. She was wheeled into trauma 1 sitting up on the gurney, stripped down to just her bra and underwear. She was wearing an oxygen mask, had EKG electrodes all over her chest, and had IVs going in both arms. “hi, I’m Dr Lindsay. Can you tell me what’s wrong?” Dr Lindsay, the ER attending from that evening asked Christine in a calm, inviting tone. Christine was gasping for air and had one hand on her chest. Her eyes were absolutely bugging out at times, and she was visibly uncomfortable. “my chest…” Christine utters to Lindsay. “your chest hurts? How long has it been hurting you?” Dr Lindsay asks in response. “since yesterday… but it got worse- a lot worse just now…” Christine tells Dr Lindsay.

On the heart monitors, Dr Lindsay saw that Christine was tachycardic, hypotensive, and had an abnormal EKG. The EKG showed unifocal PVCs with ST elevation. The doctor ordered some blood tests: a CBC, BMP, tox screen, and a stat cardiac enzyme test. An echocardiogram and chest x ray were also ordered while the blood was being drawn for the labs.

While the blood samples were sent off to the lab, the chest x ray was performed first. The only thing that was abnormal was some swelling and irritation in both lungs. This can be caused in part by Christine’s rapid, labored breathing, but it can also be associated with blood clots in the lungs, heart attacks, or fluid buildup in the lungs (for example, from pneumonia, covid, and sometimes severe bronchitis). The chest x ray definitely provided some good information, but it didn’t give Dr Lindsay the whole picture, so an echocardiogram was ordered. The echo showed right ventricular hypertrophy. Basically, the right side of her heart was enlarged and working much harder than it should. With the stat cardiac enzyme lab still pending, a dose of nitro was given for chest pain, and cardiology was called for consultation.

The two members of our cardio team to arrive were Dr Rachel, one of our cardiothoracic surgeons, and her cardio resident Dr Sarah. “hey guys, I appreciate you coming down. I think she’s having an acute STEMI and needs the cath lab, just waiting on the cardiac enzyme test to come back to confirm. What do you think?” Dr Lindsay says to the 2 cardio doctors. Dr Sarah looks at Dr Rachel, waiting for her to do the talking. “don’t look at me! What do you think of Dr Lindsay’s assessment?” Dr Rachel told Sarah, trying to get her resident to take some initiative. “I um… I agree.” The resident replies hesitantly. “why do you agree? Go on!” Dr Rachel tells Sarah. “well… um… the EKG shows ST elevation. And uh…. The patient has angina pectoris and shortness of breath.” The resident replies, nervously, and without confidence.

Nurse Nancy walks into the room with a few pieces of paper. “labs are back.” She says, handing the papers to Dr Lindsay. “Cardiac enzymes are high. This is definitely a STEMI.” Dr Lindsay says thinking out loud. “ok, let’s get her to the cath lab. We need to start a central line and get a stent in her.” Dr Rachel called out to the rest of the ER team. “what… what’s going on?” a nervous Christine asked, still breathing heavily. “you’re having a heart attack and we have to put a stent in, ok?’” Dr Lindsay tells the nervous lawyer. “a heart attack?!” Christine asks in response, surprised at what she’s heard. “am I going to die?!” Christine continued. “you’re in great hands! We’ve seen plenty of heart attacks like this. We’re going to place a stent, keep you here for a day or two, and you should be good to go.” Dr Lindsay replies with relative confidence, oblivious to the fact of what was to come. “Can you call my mom? I’m scared…” Christine asks Lindsay, still short of breath, visibly in pain from the crushing pressure she felt in her chest. “of course! We’ll have one of the nurses reach out to her, ok?” Lindsay replies, reassuring.

Over the following few minutes, Christine is taken up to the cardiac catheterization lab. She’s laid flat on the table and her bra is removed, allowing her large, D cup breasts to spill out. “alright Christine, our resident Dr Sarah will place the line and the stent. We’ll be getting started shortly.” Dr Rachel tells the nervous attorney. “the resident? I don’t want her to practice on me…” Christine protests, having a gut feeling against having the resident perform the catheterization and stent placement. “don’t worry ma’am, me and Dr Lindsay have done these plenty of times. Sarah will have plenty of adult supervision!” Dr Rachel tells Christine, attempting to add a little comedic relief to the urgent situation. Christine still had a bad feeling about it, but ultimately agreed to let Sarah perform the procedure.

The upper right portion of Christine’s chest was splashed with betadine to sterilize the area. The resident identifies the superior midpoint of the clavicle, and moves down a few centimeters. This is the location of the subclavian vein, so it’s important that the correct location be identified in the early stages of the procedure. Next, a local anesthetic is injected into Christine’s chest to numb the skin and some of the underlying tissues. She winced in pain, feeling a pinch and a burn from the injection. It normally takes 45-60 seconds for the local anesthetic to numb the area effectively, so in the meantime, an ultrasound was set up. This is to further confirm the location of the subclavian vein, and to follow the catheter’s path once placed. Next, a hollow needle was advanced through the skin. Christine could feel the pressure of the needle being inserted, but no pain. The resident Sarah advanced the needle slowly into the beautiful attorney’s chest, looking at the ultrasound monitor. Eventually, the needle was in the correct depth and blood was aspirated. The needle was held in place for a moment while the blunt guide wire was maneuvered through the needle and into the subclavian vein. While inserting the guide wire, Sarah pulled it out and inserted it again quickly, unnoticed by Rachel or Lindsay. However, everything seemed fine at the time. But in that moment, unbeknownst to everyone, Sarah introduced an air bubble into the central line, which would now become a ticking time bomb.

Eventually, the guide wire and catheter were sent to the correct location, and the occluded coronary artery was identified. A small stent was navigated into the central line and carefully and methodically navigated to the correct location. Once the stent was in place, it was placed and opened, restoring blood flow to the previously blocked artery. After confirming the placement of the stent via ultrasound and x ray, the guide wire was removed and a port was left in the initial site to leave the central line open for the duration of Christine’s hospital stay.

After the procedure was completed, Christine was brought back to an exam room in the ER to wait until a bed opened up in the recovery area. “how’re you feeling?” Dr Lindsay asked. “I definitely notice a difference. Thank you…” Christine replied, no longer breathing heavily, and seemed a lot more calm than earlier. “look who’s here!” nurse Nancy says excited, bringing Christine’s 70 year old mother Marie into the room. Marie hurries over to the bed as fast as her 70 year old body can, and gives her daughter a hug and a kiss. “How are you doing sweetie? They said you had a heart attack!” the concerned mother asks. “I’m doing a lot better mom! Thanks for coming.” She replies, with a smile on her face. “we’ll leave you two alone. It’s been quite a day, right?” Dr Lindsay said, exiting the room with nurse Nancy.

Approximately 2 hours go by. “something’s wrong! Come in, quick!” 70 year old Marie shouts to the ER team while scurrying out of the exam room, visibly worried. Dr Lindsay, nurse Heather, and nurse Nancy head into the room. The heart monitors are chirping loudly, showing that Christine is severely hypotensive and tachycardic. Christine’s eyes are shut, but she’s groaning. “christine? What’s wrong?” Dr Lindsay asks, doing a gentle sternal rub, to which Christine doesn’t respond. “she passed out and won’t wake up! What happened?!” Marie asks in a panicked tone. “We’re gonna get to the bottom of this, ok?” Dr Lindsay replied. Heather shined a pen light into Christine’s eyes and both pupils were fixed and dilated. “Pupils blown Linds” Heather tells Lindsay, shaking her head. “lets get her intubated! Get cardio back down here NOW!” Lindsay shouts, wondering what the hell just happened. “christine? Can you squeeze my hand?” Lindsay asks, receiving no response. Marie was holding her daughter’s other hand and talking to her while chaos ensued. “get me a 7.0 ET tube!” Lindsay shouted.

The ET tube was being navigated carefully into the woman’s airway by Lindsay. “no pulse, starting compressions!” Heather called out. “damn it!” Lindsay said frustrated, finishing her rapid sequence intubation. Heather delivered deep, violent chest compressions on Christine while her 70 year old mother continued to hold her hand and stroke her hair. “she’s in PEA. Push epi and atropine. And where the hell’s cardio?!” Dr Lindsay shouted again, frustrated. While Lindsay ambu bagged and lead the code, Heather continued delivering CPR. Christine’s chest caved in, and her belly jiggled outwards. Her breasts shook and trembled from the residual force of the compressions being received.

Dr Rachel and Sarah enter the room and are shocked, seeing their seemingly stable patient having her chest pumped violently. “what happened?!” Rachel asked, stunned. “I figured you two might try to figure that out for us. Any ideas?” Lindsay replied sternly. “what do you mean? She was fine a little while ago!” Rachel replied. “sarah even did a good job on her first stent placement and central line.” Rachel continued. “wait! This was the first time she ever operated on someone?!” Marie shouted, overhearing what was said. “ma’am… believe me, she is absolutely qualified. And every procedure has its risks.” Rachel replied, jumping to Sarah’s immediate defense. “did she kill my baby girl?!” Marie asked, becoming teary eyed. “Ma’am, why don’t we bring you to a private waiting room while the doctors work.” Nurse Nancy suggested, trying to gently direct the 70 year old woman out of the room. “no no no, I’m not going anywhere! That’s my daughter!” Marie shouted, tears running down her face, still holding her daughter’s hand as her chest was being absolutely pummeled.

The heartbreaking scene was interrupted by Dr Lindsay announcing that v-fib was on the monitors. “alright, charge the paddles to 200.” Lindsay called out. Nancy gently made Marie back away from the table because of the impending shock. The paddles were pressed up against Marie’s bare chest, the ambu bag was temporarily detached, and the shock was delivered. Marie’s body flopped on the table while a KA-THUNK was heard in the room. “still no change, charge to 250.” Lindsay called out, shaking her head a bit. After a cycle of compressions, the next shock was delivered. The electricity ran through the 47 year old’s limp, lifeless body, causing her to twitch sharply in response. “no pulse, let’s hit her again at 300.” Lindsay responded, looking at the monitors. “please… save my baby! That’s my little girl!” Marie begged the team while living every parent’s worst nightmare. “paddles charged.” Heather called out. The defibs were placed back onto Christine’s chest, and shock #3 was promptly delivered. Christine’s feet kicked up above the table and slammed back down half a second later, showing off the deep, soft, silky, prominent wrinkles throughout the soles of her size 7 feet. “still nothing doc.” Heather said, having 2 fingers placed on Christine’s neck for a carotid pulse. The paddles were recharged, and in a moment’s notice, Christine was shocked at 360j. Her body reacted more violently to the stronger shock, with her eyes opening up halfway, staring blankly up above. “PEA, resuming compressions.” Dr Lindsay said, taking over CPR for Heather.

More meds were pushed while CPR went on. However, it took another 6 minutes to produce another shockable rhythm. Nonetheless, when v-fib appeared on the monitors again, the paddles were recharged to 360 joules, and Christine was shocked again. Marie’s lifeless body twitched abruptly in reaction to the shock while her eyes remained open, staring blankly at the ceiling above. After another cycle of chest compressions, the next shock was delivered, causing Christine’s toes to curl, once again showing off the deep, soft wrinkles in the soles of her feet. But unfortunately at that point, the code started to become more redundant: CPR, shock, meds, repeat.

It was now 24 minutes into the code and Christine was still in v-fib. Her complexion was a ghastly pale color, her skin was ice cold to the touch, and there was a huge bruise on the center of her chest from all the CPR she’d received. At that point it was Dr Rachel doing CPR while Lindsay still ran the code. Lindsay looked around the room, eventually making eye contact with Rachel. Lindsay shook her head at Rachel, knowing Christine wasn’t coming back. Dr Rachel backed off, and nurse Heather detached the ambu bag. “what’s going on? Why are you stopping?” Marie asked the team, still holding her daughter’s hand. “I’m so sorry ma’am…” Dr Lindsay said, before Marie interrupted, “no no no! Shock her again! Keep pounding her chest! There’s gotta be SOMETHING you can do, right?!” Dr Lindsay paused for a moment, then said “I’m so sorry ma’am. We did everything we could. Your daughter’s heart won’t restart, and her brain has been deprived of oxygen for so long.” Marie started to cry at the point, practically crumbling to the floor. “time of death, 8:45pm.” Dr Lindsay said, peeling her gloves off. “no no no!” Marie wept. Nurse Nancy scurried over to try and console the woman while Heather began basic postmortem care.

The monitors were switched off, the EKG electrodes were disconnected, and the ambu bag was detached. A toe tag was filled out and placed on the big toe of Christine’s left foot, dangling in front of her beautiful, wrinkly soles. Her body was covered up, but Heather lowered the blanket down to Christine’s shoulders so Marie could have as much time as she needed to grieve her daughter’s tragic passing.

Since the exact cause of Christine’s death was unknown, an autopsy was ordered. The results of said autopsy concluded that Christine died from an air embolism that traveled to her brain. Essentially, air was introduced in the central line by Sarah, and it eventually traveled to the brain and got stuck in the smaller, more delicate vessels there. With these findings in mind, Marie was able to sue the hospital for Malpractice and received a hefty settlement payment. It was an absolute tragedy that Marie witnessed the death of her own daughter, and it was also a bit ironic that a medical malpractice attorney died from medical malpractice.

[skyloftian-nutcase]

Lofty, im curious.

If you'd care to share, are you an EMT Basic, Intermediate or Paramedic?? I just learned there was a difference haha

YOU KNOW THE DIFFERENCE :D

Intermediate is an old level that’s being phased out, though I have a coworker who is an intermediate. The national standard levels in the USA are EMT (basic), Advanced EMT, and Paramedic. I’m an advanced 👍🏻 The difference between me and a medic is I don’t do cardiac drugs (which is highly ironic considering I’m a cardiac ICU nurse and I play with cardiac drugs all the time at my nursing job lol), I don’t medically sedate people, and I can’t do certain procedures like intubation, needle decompression thoracotomy, or surgical airways (cricothyrotomy). I can start IVs and give most of the meds in our drug boxes, I can do IO and blind airways and CPAP. That kind of stuff.

I don’t usually call for a medic all that often, it has to be pretty freaking dire. I think the last time I called for one was because we were about to code a baby (baby was fine in the end, don’t worry).

[unitedhospital]

What are the Different Types and Treatments of Arthritis?

Leading a beautiful life doesn’t come without challenges. Our body goes through a lot of stress and grind in the process and there comes a stage when it needs more attention and care than ever before.

The Best Orthopedic Doctor in Bangalore at United Hospital explains that the wear and tear, our body is subjected to, leads to pain in the ankles and knees. Sometimes, it can get pretty hard to walk!

Are we welcoming Arthritis in this case?! Well, in the worst case, unfortunately, we may be. However, experts indicate that there is no need to panic. With rapid advancements in medical science, there is not just hope, but more confidence that we can defeat Arthritis.

It is all about being aware of what Arthritis exactly is and taking precautions at the right time that could be the best beginning to arrive at a successful solution.

Understanding Arthritis?

Experts at United Hospital, a dedicated Orthopedic Centre in Bangalore focusing on Arthritis care, explain that Arthritis is a medical condition involving swelling and tenderness of one or more joints. It may worsen with age and is a prevalent cause of discomfort among senior citizens

Types of Arthritis

Arthritis can affect individuals of any age, but the elderly are more vulnerable.

Some of the common forms of Arthritis are:

Osteoarthritis - It is a condition that affects joints in your Hands, Knees, Hips and Spine.

Psoriatic Arthritis - This a condition that develops in people due to a very challenging skin disease called Psoriasis.

Reactive Arthritis – This causes joint pain and swelling triggered by an infection in prominent parts of your body — most often your intestines, genitals or urinary tract.

Rheumatoid Arthritis – This is a chronic inflammatory disorder which can affect more than just joints including premier organs like lungs, heart, eyes and blood vessels.

Some of the other conditions faced notably by the elderly include Ankylosing Spondylitis.

Symptoms of Arthritis

The most common signs and symptoms of arthritis involve the joints. Hence, it is important to seek an expert opinion if you observe one or more of the following symptoms:

Pain in the joints.

Stiffness felt in the joints.

Swelling observed in or around the joints.

Redness observed in the joints.

Difficulty in moving.

Treatment for Arthritis

Arthritis, if untreated, can be a really painful thing to handle. However, what really matters is the right type of medical attention at the right time and from the right source. Your treatment is based on how severe is your condition and can include:

Medications

Depending upon the type of Arthritis diagnosed, your medications may include:

Non-steroidal anti-inflammatory drugs.

Creams and Ointments.

Steroids

Physical therapies and exercises.

Surgical Interventions

In case you do not get any relief from the above medications your doctor might recommend surgical interventions to bring you back to your routine lifestyles in quick time. Some of the types of surgeries performed include,

Joint Repairs

Joint Replacements

Joint fusions

Let’s say Goodbye to Arthritis forever and welcome a painless life. For many of us, life may begin at 40, but so does Arthritis! Hence, if you are wondering as to, “Which is the Best Orthopaedic Clinic near me to treat Arthritis”? feel free to connect with United Hospital.

[thetechempire]

World's first fully robotic heart transplant performed

🔹A groundbreaking achievement in medical technology has been made at King Faisal Specialist Hospital and Research Centre in Riyadh, Saudi Arabia, where the world’s first fully robotic heart transplant was successfully performed. The operation, lasting about two and a half hours, was conducted on a 16-year-old patient suffering from end-stage heart failure, who specifically requested that his chest remain unopened during the procedure.

🔹The surgery was led by cardiovascular surgeon Feras Khaliel, who prepared meticulously with his team, conducting seven training sessions over three days to ensure everything went smoothly. This rigorous preparation highlights the complexity and innovation involved in performing such a pioneering operation.

🔹Majid Al Fayyad, the CEO of the medical center, praised the accomplishment as a significant advancement in healthcare, drawing parallels to the historical significance of the first heart transplants conducted in the 1960s. The fully robotic approach marks a new era in surgical procedures, emphasizing precision and minimally invasive techniques.

🔹This landmark surgery not only showcases the capabilities of robotic technology in medicine but also sets a precedent for future procedures. It represents a major step forward in cardiac care, offering hope for improved outcomes in patients requiring heart transplants.

[sarvodhyahospital]

Heart Hospital in Greater Noida West

Introduction to Heart Hospital in Greater Noida West

At the Heart Hospital in Greater Noida West, we are dedicated to providing exceptional heart care. Our hospital is designed to meet the needs of patients requiring advanced cardiology services.

Heart disease remains one of the leading health concerns worldwide. Early diagnosis and effective treatment are crucial. Our hospital offers comprehensive solutions to ensure your heart stays healthy.

We believe that with the right care, heart disease can be managed effectively. Our facility is equipped with the latest technology to deliver top-notch medical services.

Choosing the right heart hospital is vital for your overall well-being. At our hospital, you receive care from some of the most qualified professionals in the field. We focus on personalized treatment plans tailored to each patient’s unique needs.

Why Choose Our Heart Hospital?

Our Heart Hospital in Greater Noida West stands out due to its advanced facilities and highly skilled medical team. We utilize cutting-edge technology to diagnose and treat heart conditions accurately.

Our state-of-the-art equipment ensures precise results and effective treatment plans. We stay updated with the latest advancements in cardiology to provide the best care.

Our team of cardiologists and surgeons brings years of experience and expertise. They are committed to delivering personalized care and ensuring the best outcomes for every patient.

We understand that heart health is critical and require careful management. Our professionals are here to guide you through every step of your treatment.

Our Services and Treatments

We offer a comprehensive range of cardiology services at our hospital. From detailed diagnostics to complex surgical interventions, our facility is equipped to handle various heart conditions.

Cardiac Diagnostics: We provide thorough diagnostic services including ECG, echocardiography, and stress tests. These tests help in accurately diagnosing heart diseases.

Surgical Interventions: Our hospital offers advanced surgical treatments such as angioplasty, bypass surgery, and valve replacements. We ensure the procedures are performed with the utmost precision.

Preventive Heart Care: We focus on preventive measures to maintain heart health. This includes lifestyle counseling, regular check-ups, and monitoring for early signs of heart disease.

Our holistic approach ensures that patients receive comprehensive care tailored to their specific conditions.

Patient-Centric Approach

At our Heart Hospital, patient care is our top priority. We believe in providing a personalized approach to treatment, focusing on the individual needs of each patient.

Our staff is trained to offer compassionate and attentive care. We understand the emotional and physical challenges of heart conditions and are here to support you throughout your journey.

We offer various support services including nutritional guidance, psychological support, and rehabilitation programs. Our goal is to help you recover and maintain a healthy lifestyle.

How to Book an Appointment

Booking an appointment at our Heart Hospital is simple and convenient. You can choose to book online through our website or contact us directly via phone.

Our online booking system allows you to select a suitable time and date for your appointment. Alternatively, you can call our reception for assistance.

For more details or to schedule an appointment, visit our website or reach out to our customer service team. We are here to help you with all your heart health needs.

Patient Testimonials and Success Stories

Our patients’ experiences speak volumes about the quality of care we provide. Many have shared positive feedback about their treatment and recovery at our Heart Hospital.

Real-life stories highlight the success of our medical interventions and the dedication of our healthcare professionals. Patients have expressed gratitude for the personalized attention and effective treatments they received.

These testimonials reflect our commitment to delivering excellent care and achieving positive outcomes. We take pride in the trust our patients place in us and strive to continue providing exceptional heart health services.

[anjaliverma123]

Navigating Healthcare Excellence: Finding the Best Treatment Across Specialized Fields

Introduction

Finding the right course of action in the complex world of healthcare demands careful investigation and well-informed decision-making. Whether you're looking for a top-notch kidney dialysis facility, a skillful shoulder surgeon, heart transplant surgery choices, or specialty facilities for autism treatment, our comprehensive guide will hopefully help you get the best possible care.

Locating Find Best Treatment: A Basis for Health

Seeking optimal health necessitates thoughtful deliberation and well-informed choices. Consulting with licensed healthcare providers is essential for determining each patient's unique medical needs and developing individualized treatment programs. Modern medicine offers a wide range of treatments, such as prescription drugs, surgical procedures, lifestyle changes, and complementary and alternative therapies. Navigating the wide range of treatment options requires open communication between patients and healthcare providers. The foundation of a customized and successful treatment plan is the collaboration of medical knowledge with well-informed decision-making.

Best Orthopedic Care: Seeking the Best Shoulder Surgeon

The knowledge and experience of a highly qualified shoulder surgeon in pune is invaluable when it comes to shoulder ailments and injuries. Examine the qualifications and experience of orthopedic specialists in your region to start your search. Seek out doctors that have experience with successful shoulder surgeries, are knowledgeable about the most recent developments in orthopedic care, and specialize in shoulder-related procedures. Referrals from other medical specialists and patient testimonials can offer important information about the surgeon's skill and patient happiness.

A Closer Look at Kidney Dialysis Hospitals: Ensuring Quality Care

This investigation explores the world of kidney dialysis hospitals and examines their procedures to guarantee the provision of top-notch care. By exploring the nuances of dialysis practices, hospital architecture, and medical procedures, this summary seeks to highlight the critical function these institutions perform in the treatment of kidney-related diseases. The discussion navigates the landscape of kidney dialysis to emphasize the significance of upholding strict standards in these specialized healthcare settings by focusing on the elements that contribute to quality care, such as qualified medical professionals, cutting-edge technology, and stringent safety measures.

Heart Transplant Surgery: Exploring the Pinnacle of Cardiovascular Care

For those with end-stage heart disease, heart transplant surgery offers a second shot at life and is the ultimate in cardiovascular therapy. The process of selecting the ideal facility entails a careful assessment of the hospital's transplant program. Take into account elements including the transplant team's success rates, the accessibility of donor organs, and the quality of the post-transplant care offered. Heart transplant surgery is ensured to be thorough when a multidisciplinary team of cardiologists, surgeons, and rehabilitation specialists collaborates. Examine the hospital's track record, achievements, and patient endorsements to help you make an educated choice when seeking the best possible cardiac care.

Autism Treatment Hospitals: Tailoring Care to Unique Needs

Care for people with autism spectrum disorder (ASD) must be customized to meet their individual needs. When searching for the finest hospital for autism treatment, give special consideration to establishments that use a multidisciplinary approach. Seek out medical facilities that employ licensed behavioral analysts, occupational therapists, speech therapists, and neurodevelopmental specialists. Consider whether evidence-based therapy, including Applied Behavior Analysis (ABA), are available, and find out about family support services. Interact with medical professionals that value the patient-centered approach, creating a cooperative and encouraging atmosphere for people with autism and their families.

Conclusion

In the field of medicine, finding the optimal course of action requires a combination of dedication, investigation, and teamwork. Making educated judgments is crucial, whether you're looking for a shoulder surgeon, researching kidney dialysis centers, thinking about heart transplant surgery, or figuring out your options for treating autism. You can take control of your healthcare experience and make it exceptional for you by using patient testimonies, learning about hospital reputations, and interacting with medical personnel. Recall that the road to perfect health is paved with decisions made with information and a dedication to all-encompassing, patient-centered care.

[mcatmemoranda]

Patient is a [ ] yo male/female presenting to the clinic for a preoperative evaluation.

Procedure [ ]

Scheduled date of procedure [ ]

Surgeon performing procedure requesting consultation for preop is [ ] and can be contacted at [ ]

This patient is/is not medically optimized for the planned surgery, see below for details.

EKG collected in office, interpreted personally and under the direct supervision of attending physician as follows- sinus rate and rhythm, no evidence of ischemia or ST abnormalities, no blocks, normal QTc interval.

The following labs are to be completed prior to surgery, and will be evaluated upon completion. Procedure is to be performed as scheduled barring any extraordinary laboratory derangements of concern.

Current medication list has been thoroughly reviewed and should not interfere with surgery as written.

Patient has no prior history of adverse reactions to anesthesia, problems with airway management, difficult IV access, prolonged emergence, or postoperative nausea/vomiting.

Airway Mallampati score: This patient is a Grade based on the criteria listed below

-Grade I Tonsillar pillars, soft palate, entire uvula

-Grade II Tonsillar pillars, soft palate, part of uvula

-Grade III Soft palate, base of uvula

-Grade IV Hard palate only, no uvula visualized

Patient is a low/medium/high risk for this low/medium/high risk surgical procedure.

Will send documentation of this preoperative visit to surgeon [ ].

**** ADDITIONAL INFORMATION****

Patient Risk for Elective Surgical Procedure as Determined with the Criteria Below:

1- Very Low Risk

No known medical problems

2- Low Risk

Hypertension

Hyperlipidemia

Asthma

Other chronic, stable medical condition without significant functional impairment

3- Intermediate Risk

Age 70 or older

Non-insulin dependent diabetes

History of treated, stable CAD

Morbid obesity (BMI > 30)

Anemia (hemoglobin < 10)

Mild renal insufficiency

4- High Risk

-Chronic CHF

-Insulin-dependent diabetes mellitus

-Renal insufficiency: creatinine > 2

-Moderate COPD: FEV1 50% to 70%

-Obstructive sleep apnea

-History of stroke or TIA

-Known diagnosis of dementia

-Chronic pain syndrome

5- Very High Risk

-Unstable or severe cardiac disease

-Severe COPD: FEV1 < 50% predicted

-Use of home oxygen

-Pulmonary hypertension

-Severe liver disease

-Severe frailty; physical incapacitation

Surgical Risk Score Determined as Below:

1- Very Low Risk

Procedures that usually require only minimal or moderate sedation and have few physiologic effects

-Eye surgery

-GI endoscopy (without stents)

-Dental procedures

2- Low Risk

Procedures associated with minimal physiologic effect

-Hernia repair

-ENT procedures without planned flap or neck dissection

-Diagnostic cardiac catheterization

-Interventional radiology

-GI endoscopy with stent placement

-Cystoscopy

3- Intermediate Risk

Procedures associated with moderate changes in hemodynamics, risk of blood loss

-Intracranial and spine surgery

-Gynecologic and urologic surgery

-Intra-abdominal surgery without bowel resection

-Intra-thoracic surgery without lung resection

-Cardiac catheterization procedures including electrophysiology studies, ablations, AICD, pacemaker

4- High Risk

Procedures with possible significant effect on hemodynamics, blood loss

-Colorectal surgery with bowel resection

-Kidney transplant

-Major joint replacement (shoulder, knee, and hip)

-Open radical prostatectomy, cystectomy

-Major oncologic general surgery or gynecologic surgery

-Major oncologic head and neck surgery

5- Very High Risk

Procedures with major impact on hemodynamics, fluid shifts, possible major blood loss:

-Aortic surgery

-Cardiac surgery

-Intra-thoracic procedures with lung resection

-Major transplant surgery (heart, lung, liver)

High risk surgery: yes/no

Hx of ischemic heart disease: y/n

Hx of CHF: y/n

Hx of CVA/TIA: y/n

Pre-op tx with insulin: y/n

DM/how are blood sugars?

Pre-op Cr >2mg: y/n

OTHER EVALUATIONS BASED OFF PATIENT HISTORY SEE BELOW:

1. CARDIAC EVALUATION

A. Ischemic Cardiac Risk- Describe any history of cardiovascular disease and list the cardiologist/electrophysiologist. For CAD, report the results of the most recent stress test or cardiac cath, type of procedures or type of stents, date of MI, and recommendations for perioperative management. Include antiplatelet management. Continue baby aspirin for patients with cardiac stents - unless having neurosurgery, then coordinate with surgeon.

B. Ventricular function - include most recent echocardiogram evaluation ideally performed within the past 2 years

C. Valvular heart disease- include most recent echocardiogram, type of prosthetic valve

D. Arrhythmias - include any implanted devices and recent interrogation report, contact electrophysiology about device management during the surgery and include recommendations provided. For A-Fib, include CHA2DS2-VASc score

E. Beta blockade - All patients on chronic beta blockers should have these medications continue throughout the perioperative period unless there is a specifically documented contraindication.

F. Hypertension - Other than for cataract surgery, ACEI inhibitors and ARBs should be held for 24hours prior to surgery and diuretics should be held the morning of surgery

G. Vascular disease - include antiplatelet management and dates of strokes

2. PULMONARY EVALUATION

A. COPD/Asthma - include any recent exacerbations, intubations, chronic O2 use, amount of rescue inhaler use

B. OSA risk - STOPBANG score - address severity of sleep apnea and CPAP use

3. HEMATOLOGIC EVALUATION

A. Bleeding Risk - assess the bleeding risk and history for every patient

B. VTE Prophylaxis/Thrombotic risk - estimate risk and provide recommendations

C. Anticoagulation management - include pre-op and post-op medication instructions

D. Anemia - pre-op treatment plan

D. Oncology - history and treatments

4. ENDOCRINE EVALUATION

A. Diabetes mellitus - include type, medication use, recent A1c, pre-op and post-op management instructions

B. Adrenal insufficiency risk - assess for prolonged steroid use in the last year

5. RENAL EVALUATION

A. CKD - include stage, baseline labs

B. ESRD - include dialysis schedule, type, access, dry weight, location of dialysis. Generally, surgery should not be scheduled on a dialysis day.

C. Electrolyte abnormalities

6. GI EVALUATION

A. Liver disease - including MELD score and Child-Pugh classification

7. OTHER relevant comorbidities or anesthesia considerations

[substance abuse, chronic pain, delirium risk, PONV (post-operative nausea and vomiting) risk, psych disorders, neurologic disorders, infectious disease, etc.]

[jitendrasm]

Understanding Venous Air Embolism: Timeframe and Potential Risks

Introduction

In the world of medical emergencies, knowledge can make all the difference. One critical condition that demands immediate attention is venous air embolism (VAE). Understanding the timeline and potential risks associated with VAE is essential for healthcare professionals and individuals alike. In this article, we'll delve into the question, "How long does it take for a venous air embolism to be fatal?" while shedding light on what VAE is, its causes, symptoms, and preventive measures.

What is Venous Air Embolism (VAE)?

Venous air embolism (VAE) is a potentially life-threatening condition that occurs when air enters a person's bloodstream through a vein. The presence of air bubbles in the bloodstream can disrupt normal blood flow and lead to various complications, including organ damage and, in severe cases, death.

Causes of Venous Air Embolism

VAE commonly occurs during medical procedures that involve the manipulation of veins or when the body is in a position that allows air to be drawn into the bloodstream. Common scenarios where VAE may occur include:

1. Surgical Procedures: Surgeries that require the use of central venous catheters, cardiopulmonary bypass, or any procedure where veins are exposed can potentially introduce air into the bloodstream.

2. Invasive Medical Procedures: Insertion or removal of central lines, hemodialysis, and certain obstetric procedures can create opportunities for air to enter the veins.

3. Childbirth: During childbirth, especially if a woman is in certain positions, there is a risk of air embolism.

Symptoms and Immediate Risks

The onset of symptoms due to VAE can vary depending on the amount of air that enters the bloodstream and the patient's overall health. Common symptoms include difficulty breathing, chest pain, confusion, dizziness, and in severe cases, loss of consciousness or cardiac arrest. 

As for the question, "How long does it take for a venous air embolism to be fatal?" the timeline can be swift. In cases where a significant amount of air enters the bloodstream and reaches vital organs, the effects can be fatal within minutes to hours if not promptly addressed.

Preventive Measures and Treatment

Preventing VAE involves careful attention to procedural techniques and patient positioning. Here are some preventive measures:

1. Proper Positioning: Keeping patients in positions that prevent air from entering veins is crucial. This is particularly important during surgeries and procedures.

2. Central Line Insertion: Using proper techniques for central line insertion and removal can minimize the risk of air embolism.

3. Alertness: Vigilance among medical professionals is essential. Monitoring patients for signs of VAE during procedures can lead to early detection and timely intervention.

Conclusion

Venous air embolism is a serious medical condition that demands swift action and knowledge from medical practitioners. While the time it takes for VAE to be fatal can vary, the consequences of not addressing it promptly can be severe. Understanding the causes, symptoms, and preventive measures associated with VAE can save lives and enhance patient safety during medical procedures.

For more information or if you have concerns about VAE, consult with a medical professional or visit reliable medical sources. Remember, knowledge is a powerful tool when it comes to medical emergencies like venous air embolism.