Morning guys. I'm Siobhan, a second-year medical resident. It's super early in the morning.
I'm just starting my cardiology rotation. And with that comes a new motivation to be working out in the mornings.
So I feel like I'm barely awake, but I'm so proud of myself for getting to the gym.
I'll touch base with you guys when I'm done and we'll head to the hospital.
So I'm done one week of Cardiology now and to be honest
It's a little bit overwhelming because being on a subspecialty service like this, there's a lot of detail a lot of complicated cases
So the basic cardiology knowledge that you become so familiar with, this sort of bumping it up to the next level
So it's excellent. They're great teaching
But I feel him I'm working hard and studying a lot at night
So heading up to the cardiology unit and we're gonna hear about handover, anything that happened overnight, they make a plan for the day
Okay, so the first patient that I've seen has heart failure and that sounds really
Dramatic, it sounds like your heart is about to stop
But it's actually a diagnosis that a lot of people on the ward have and it basically means that the heart either can't squeeze well
or it can't relax well and
In other words, they're not able to pump the way that they should
So if you're not pumping well, then fluid starts to get backed up and that can get backed up into the lungs
which is pulmonary edema or it can get backed up into the abdomen you can get something called ascites or
Into the legs and you get pitting peripheral edema
So when you see people with really thick legs full of fluid. This particular patient came in almost
50 pounds heavier than usual because it's all water weight, so you can imagine when all this fluid is going other places
Into the lungs, into the abdomen, into the legs, then all of a sudden the kidneys start thinking: oh, man
I'm so dehydrated because there's not as much fluid in the actual vessels
So they start retaining fluid and that's how you end up with 50 pounds of water weight
So the first thing I'm gonna do is check out this patient's weight. The computer screen is right behind you. I can't show you that
But I can see that their weight is coming down nicely because we're giving them a water pill so they're peeing out
I'm also gonna check out how much they're actually peeing
Then I'm checking with his blood work. It's kidney function
His electrolytes, I can see actually the potassium is a little bit low, so we'll replace that
And anyway, let me go and actually see the patient, see how he's doing, not just look at the computer screen
Okay, so he is doing so much better, he's off of oxygen, feeling better, breathing better, sleeping better
So going in the right direction, but there's still a lot of fluid to come off of him. So
Definitely continuing on with the diuretics, the water pills for now
so next I'm going to see a patient who has valve disease meaning their valve is really tight and when you picture
Pumping blood through a small area. You can't get as much through. So that's the problem here
So they're probably going to need surgery to replace a valve in the meantime
We'll prescribe some medications to help optimize the heart pumping
Now we gather to round as a team of medical students, residents,
pharmacists and staff cardiologists
Since we've already seen our patients in detail this morning, we present a summary of our findings and suggest a plan
Then you get direct feedback from the experienced cardiologist
he might question you on why you made that decision or help refine your plan and
That often leads to teaching moments. Running in here to grab some almonds just on a break, get the energy up and head back in
Now that we're done with our patient care we can actually do a formal teaching session
Now we're heading downstairs for this cardioversion, everyone excited? yeah
So cardioversion is a procedure then to convert an abnormal heart rate back to a normal heart rate
In this case the patients presenting with atrial fibrillation
Which basically means that the heart is just randomly beating, causing an irregular heartbeat
with a fast irregular heartbeat the heart isn't really pumping efficiently and patients can feel symptoms like
palpitations, shortness of breath or chest pain
Cardioversion can be done with medications or with an electrical shock to the chest. In this case
We'll be sedating the patient with propofol before giving that shock
The pads are placed in the patient's chest and we charge to 200 joules of energy
Before shocking you always say: ''I'm clear, you're clear, we're all clear'' and then you push the button and
Like magic, the patient is back in a regular sinus rhythm, although still a little bit groggy from the propofol
end of the day
Taking off the stethoscope, off duty.
All right, I'm heading out now, it is been a wonderful day. I will tell you though, that I feel exhausted
There's no way I would ever go to the gym at this point. So I'm very proud of myself for going in the morning. Uh,
Anyway, if you want to see more videos like this, don't forget to subscribe and otherwise
I'll be chatting with you guys next week. Bye for now