This week’s rotation was spent at Montefiore
Hospital in the Bronx rounding in the CCU as well as in the advanced coagulation
laboratory. There were some interesting and emergent admits to the CCU while we
were on the floor. One patient had an allergic reaction to the contrast dye
used to visualize the coronary arteries. A second patient was in supraventricular
tachycardia (SVT) and was experiencing a resting heart rate of over 160 bpm;
the patient was intubated and needed to be shocked in-order to reset the heart
to a normal rhythm. A third patient was in dire need of a heart transplant and
was being supported with an extracorporeal membrane oxygenator (ECMO). Briefly,
an inflow tube is connected to the right atrium, flows to an oxygenation
device, and then is inserted well downstream in the aorta—bypassing the lungs.
It is sometimes a difficult art/craft in determining the correct cannula size
and pump speed. The cannula need be large enough for sufficient flow, yet too
high a flow leads to hemolysis and platelet activation.
Time in the coagulation laboratory
was utilized crunching data for part of my project: the Sildenafil to Prevent
Clot (STOP Clot) Study. The study will be elaborated in future arenas, but the
premise is to analyze whether Sildenafil can alter endothelial cell function
and potentially reduce stroke risks in LVAD patients. A patient was admitted to
the study on Thursday; routine blood draws were taken and analyzed for platelet
function and coagulability.
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