Friday, July 12, 2019

Week 5- Grant


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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