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The idea of doing Critical Care to some in the Anesthesia world is a nuisance. Some residents will dread the ICU months and in actuality for good reason. You get pummeled with scut work, long overnight calls and hours of pedantic rounding and re-rouding. You take care of patients transiently and never have ownership over the outcome.
Last week I had one of those cases that makes you glad to be a doctor, and for me, glad to be an Intensivist.
59 y/o WF with hx of breast CA and who is 4 wks s/p fibular fracture passes out at work. EMS brings her into the emergency and the ED docs promptly start heparin and send her to the CT scanner. I get a call from ED doc "Is this the ICU doc on call?" "Yes" i reply. "Well i have a lady down here with a saddle embolus on her CT scan and since she has returned from the study i have not been able to get BP, can you come help me?"
Long story short I get there she has a femoral pulse but CUFF not reading, I order TPA, Call interventional Cardiologist. I place a central line start some emperic norepi and dobutamine and then a left femoral ALine after failed attempts at radial even with U/S.
She goes PEA moments later. 2 rounds of EPI/Atropine, 40 of vaso she comes back. Off to cath lab where they do some mechanical clot busting.
Next morning I extubate her.
The most fulfilling part of all of this, was how grateful the family and the patient were. To her i was her doctor and i saved her life (something she and her husband tell me). Her husband probably thanked me 20 times over 2 days.
Today i followed up to see how she was doing now that she was out on the floor and I had some time b/w anesthetics. She looked great on a 2L NC. She thanked me once again.
Often in anesthesia we are the offensive lineman of surgery. We make it happen but never get the credit from the nurses or more importantly the patients. This was an opportunity to get to see how the quarterback feels.
Last week I had one of those cases that makes you glad to be a doctor, and for me, glad to be an Intensivist.
59 y/o WF with hx of breast CA and who is 4 wks s/p fibular fracture passes out at work. EMS brings her into the emergency and the ED docs promptly start heparin and send her to the CT scanner. I get a call from ED doc "Is this the ICU doc on call?" "Yes" i reply. "Well i have a lady down here with a saddle embolus on her CT scan and since she has returned from the study i have not been able to get BP, can you come help me?"
Long story short I get there she has a femoral pulse but CUFF not reading, I order TPA, Call interventional Cardiologist. I place a central line start some emperic norepi and dobutamine and then a left femoral ALine after failed attempts at radial even with U/S.
She goes PEA moments later. 2 rounds of EPI/Atropine, 40 of vaso she comes back. Off to cath lab where they do some mechanical clot busting.
Next morning I extubate her.
The most fulfilling part of all of this, was how grateful the family and the patient were. To her i was her doctor and i saved her life (something she and her husband tell me). Her husband probably thanked me 20 times over 2 days.
Today i followed up to see how she was doing now that she was out on the floor and I had some time b/w anesthetics. She looked great on a 2L NC. She thanked me once again.
Often in anesthesia we are the offensive lineman of surgery. We make it happen but never get the credit from the nurses or more importantly the patients. This was an opportunity to get to see how the quarterback feels.
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