A Locums ScrapBook: A Day in the Life…

“I joked with the crew, and said, we are in the land of the Paramedics, cuz that’s pretty much all you could see.”

Editor’s Note:

To view the entire “Locum’s ScrapBook” series- click here

I’m doing some perfusion traveling as I am taking my show on the road.  As such, every once in awhile I will be dropping a few notes and pictures of places visited, and observations made.  In a sense, the beginning of a scrap book on Open Heart Surgery in America (and other places if possible).

44 hospitals and counting (places I have engaged CPB).

Enjoy 🙂

Frank

Early dawn in the OR today 🙂

A day in the life…

It was one of those days that catches you by surprise by the time it’s all said and done.  Innocuous start to the day, basically just one cell-saver case (pretty much collection only) on a spine, should take about 90 minutes- and that will be that right?

NOT!

Forty minutes into the case, I get a breathless phone call from my colleague who is on cardiac cath lab call- can I get down there and help with a balloon that’s going in as we speak?  I tell her sure, shag it down to CCL, and the IAB is already in- all I have to do is hook it up and help transport.  Good enough.  I call my colleague back- tell her “I’ve got this” and wave her off from hurrying in.  IABP is transported to ICU, I speak with our heart surgeon about the “if and when” possibilities of this patient going to surgery for a CABG– no news yet, waiting to see the echo.  EF is undoubtedly pretty low.

Back upstairs, finishing the cell saver spine case, two ortho cases get added and my colleague is going to handle those…  So I head home.

Text message from our heart surgeon- we are going to transfer this patient to a sister facility- basically a larger metropolitan hospital (that can absorb the risk- in terms of numbers) about an hours’ drive away.  This is going to happen sometime this afternoon, and that certainly alters my day, as perfusion transports IABP’s here at this institution.

In the elevator heading to the ambulance bay…

So I head back in, talk with my colleague for a bit, find out we have added two cell saver cases running simultaneously  and next thing I know she is headed back to the cath lab for a full-on code blue!  I hear the overhead speaker system paging PERFUSION TO THE CATH LAB STAT- and after checking on the blood loss on both cases- head down to the CCL to check things out.

Full compressions and a huge crowd, I let my colleague know I’ll take over her cell saver cases- while she stays to put another IABP in.  Of course, still looming is this 3 hour transport run, which could go down at anytime, so to be safe, I call another team member to come in and assist- because I could take off anytime.

Christine, BSN waiting to transport with us 🙂

The patient survives the code, balloon is in, transported to ICU, I have processed 1000 ml of blood on one case, and I get the call to transport, just as more perfusion help arrives to cover the autotransfusion cases.

So this is my first time EVER balloon transport- and the Datascope 300s console is designed to be disengaged from its cart- to make a smaller footprint in the ambulance.

Another first, as I have never seen or done it before (detaching the pump from the console), but went over the steps with someone who had, just prior to starting the move to another facility.  Well it does come apart rather easily, a well thought out design, and we needed every inch of space in what was a mammoth ambulance/truck.  Noteworthy to mention?  Those CS300’s are super heavy, and I totally tweaked my back lifting it in (took two people to do it- and it was still tough.

Meet Clayton, Paramedic and a very cool dude- he wants to be on an Air Rescue team

But we got it done, and the first part of the trip- I was standing up holding on to an overhead bar, similar to riding a subway in Manhattan- very shaky ride.  I was thinking to myself that the circuit boards on most of our equipment might just snap off due to the constant shake and bumps- and then we are toast to say the least.

Did a mini balloon pump class for Clayton while in transit…

Clayton- deliberating on the concept of “afterload reduction”

The trip took about 60 minutes, which was excellent considering we were driving through rush-hour traffic.

A view from the top- looking backwards…

Arrival went without a hitch, and there had to be 5 or 6 ambulance crews either coming or going, from all corners of the state- this was definately a “Final Destination” hospital!

I joked with the crew, and said, we are in the land of the Paramedics, cuz that’s pretty much all you could see.

At the ICU, we switched to their IABP console, and after an eternity of wandering through this maze of hallways, we found our way back to the elevator that took us up to ICU-

Breanna EMT (driver), Clayton, and Christine.  A fun team to work with!

And off we go, empty equipment in hand, heading back from whence we came!

It was a FUN day… from 0 to 60mph- JUST LIKE THAT 🙂