Hey guys! I am Siobhan, a 2nd-year medical resident. I am currently on a 24-hour call shift with cardiology. I have never done this before, so it's new and I am a little bit nervous and, oh my gosh, what are the odds that while I am filming this already starts?!
okay I need to find a phone
Music
Hi, this is Siobhan from Cardiolgy returning a page..
Right, umm, so how long?
Okay, sounds good. Great. Thank you.
(O)k. Bye.
Okay so i just found out that there's a patient
from the community; who's being transferred to our hospital
And because they're having a bad heart attack,
and they need to have an intervention
So i'll explain more later but right now I need to call my Fellow and let them know that the patient is 15 minutes away
Hey, Yeah, it's Siobhan.
Umm, I know, it happens so soon. You're right, its a STEMI.
so they say the patient is coming from 20 mins away so we should be there in 15 mins or so.
Okay. Great. Yeah, i'll meet you at the Cath Lab.
OK, Thanks, K, bye.
So, while we're waiting for the patient to arrive; let me breakdown what is actually happening during a heart attack.
There are blood vessels that wrap around the outside of the heart and that's how it gets Oxygen.
If one of those vessels gets blocked, part of the heart stops receiving Oxygen and it starts to die.
When the heart cells become damaged, they release a protein called Troponin.
So, If i'm worried a patient is having a heart attack; I check their Triponin level in the blood and i'll get an ECG.
During a heart attack, Electricity doesn't conduct normally through the heart; and you'll see something called ST-elevation on the ECG.
That's why we call it a ST-elevation MI, or a STEMI.
Seeing this makes me super concerned; we say that time is muscle, so the longer the blood vessel is blocked, the more damaged the heart becomes.
So it's critical to get the patient to the hospital and open up that blockage.
{Ambulance sirens}
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Our 20 minutes are up and the patient is being wheeled into the heart investigation unit. With each minute more damage is being done to the heart.
I wish you could see how quickly and efficiently this medical team moves.
A wire is threaded up the artery in either the groin or the wrist, all the way up to the heart.They shoot dye into the artery to see where the blockage is.
Then they deploy a balloon to open it up, and a metal stent is placed there to keep it open.
Just like that, blood flow is restored to the heart.
Finally, we bring the patient to the recovery room and do the less exciting stuff.
THE PAPERWORK :'(
Alright, so we got the good ultrasound machine
(Laughing) 'The Cadillac' of all the ultrasounds
OK, so we're heading to the ICU right now to ultrasound a patient's heart, looking for something called Tamponade.
So that's when you got fluid around the heart that is building up a lot of pressure so it can't pump well.
Alright; mission accomplished! We do not think that patient has Tamponade.
So, that's a good thing :)
So, let's celebrate? Celebrate, by doing the two other consults we have pending.. (Laughter) OK, so we're heading up to do those.
The first consult is for Tachycardia. In the end, we largely think this is to do with pain and the anxiety the patient is feeling.
But, we'll check back later tonight to see if things are improving throughout the night.
Then, the second consult was for chest pain.
And then we actually think this is likely Pericarditits; which is when the sack around the heart gets inflamed.
So we're starting some anti-inflammatories and sending off bloodwork to look for causes of the Pericarditis.
I just got paged about a patient who is very nauseous, one of our cardiac patients
And nausea, vomiting, can be related to the heart, and a heart attack; but that doesn't sound like the cause. But anyway, i'm going to see this patient to see what's going on
and make sure it's nothing too serious; try make them feel a bit better. :)
Well, Sally, thanks for the food! That is awesome!
I'll call you when there's a consult and we'll figure it out from there? (Of course) Alright, perfect!
Finally, a moment of rest!
(CODE BLUE:LEVEL 1) Nope, no time for sleep now!
So, it's 02:00 AM right now, things actually seem OK; dare I say it
The pager hasn't gone off in a little while,
And I have nothing to do, so i'm going to go to my call room and try and grab some sleep
I'm pretty awake but I can feel the fatigue is under the surface, waiting there
Its 3 AM, I just got paged to come and do another urgent Echo, looking again at Tamponade
So i'm just grabbing the Fellow (Sally? Salleh? ) And we'll do that together
Well, he's going to do it
i'm just going to watch.. And help.
What time is it? (6AM ) Exhaustion has set in. We got some Coffee; well, i got some tea, and we'll make it through the last couple of hours of the night
Just leaving now, I must say I was really nervous for this call shift: worried for the acuity.I had so much support from Sally / Salleh?
I want to thank him so much for being in the video (Corrections and clarification needed for your name bud) and giving me so much support over night
It was a great learning experience and I felt safe so that's the most important thing
Anyways there's going to be lots more videos like this so don't forget to subscribe if you want to see more like this
Otherwise, i'll be chatting with you next week; so bye for now! [ Subs by Richard Macey]
Whoops! Nearly left with teh CCU call room key, the next resident would not be happy with me! :(