dissections

dissecting aortas, that is!

wasn't personally involved in caring for the patient - but my friend was. turns out the intial complaint was of upper back pain, not resolving despite iv morphine. On his very good suspicion - CT aortogram was done, which showed...

A STANFORD A DISSECTION.

WHAT THE BLOODY HECK! how rare are these compared to msk strains and the like!!!! omg. @_@

so vascular came down to see patient - arrangements made for him to be transferred to a level 1 cardiothoracic surgery centre were in place, and ambulance was right outside waiting, when...

THE PATIENT COLLAPSED.

again, WHAT THE BLOODY HECK! he went into VF and was shocked. at some point, the vascular attending was there along with the vascular and CTS senior residents (having driven madly down from the level 1 centre). omg.

decision for emergency thoracotomy was made, and internal cardiac massage done. it was so abso-bloody-lutely thrilling to watch the heart being massaged and shocked with internal paddles, a feeling i cannot quite describe except that my heart was in my throat, hammering away, and felt like it was about to jump out at any minute.
there was SO MUCH BLOOD evacuated from the pericardial cavity. that must have been some dissection (and it was, when i saw the CT scan!).

it was all very well and thrilling, until they decided to call off the resus. the patient's daughter is from the same college as me, and i felt so super sad when she turned up in her logo shift and college badge :( :( :(
i mean, things always hit closer to home when you can relate somehow, eh?

am totally grateful that i managed to witness all that (hiding behind curtains, perched on a stool, hidden by the human wall of nurses). it was really quite amazing, not to put too fine a point on it. well worth my staying back over an hour to see what happened!

emed simultaneously repulses and thrills me. i detest drunks/regulars, but i absolutely LOVE the thrills of a resus! seriously considering emed, but i'm not quite sure if i can actually give up ob/gyn or the OT!