Blog — Notes of a Plastic Surgeon

Welcome to my blog. I am a plastic surgeon in Seattle and have been in private practice since 1991. I've seen more than a few interesting faces and cases through my years spent in the exam room, the operating room and the emergency room. And I have an opinion on just about everything relating to plastic surgery (and a lot of unrelated stuff). If you like my blog, let me know. Thanks for reading! Lisa

Seattle Plastic Surgeon Saves Resusianne (for the umpteenth time).

Resusianne saved once again by Seattle Plastic Surgeon. 

Last Saturday I had my biyearly Advanced Cardiac Life Support review and examination.  After an excellent review of heart rhythms, various resuscitation drugs,  much studying and fretting and sweating bullets while taking the written exam, I was taken into a small room by a seasoned and tough-as-nails intensive care unit nurse.  There, on the table, lay Resusianne.  After many years of saving her life, I just call her Anne for short.  I don’t really care for her much but only because she makes me so nervous.  You see, she is always trying to die on me.

Resusianne lives yet again.

Resusianne lives yet again.

My nurse examiner starts with the scenario that I’m in Nordstrom’s and come across a woman who is laying, unmoving on the floor.  My first thought is sticker shock at the price of this bikini but I keep that to myself.  I automatically go though the drill that has been beat into me over three decades.

“Anne! Anne! Are you okay?”  Of course she’s not okay.  Resusianne is never okay but it seems polite to ask.  “I need help!  Someone call 911 and someone bring an AED.”  And then I start CPR.  Now the fun starts when the AED arrives.  I have to fumble for the on switch, rip open Anne’s shirt (fun!) and put on the paddles and then start CPR again until the AED tells me to stop.  And then it seems like an hour before the AED decides to shock Anne.  As soon as the shock is completed, I start in on CPR again until the nurse has mercy on me and tells me I can stop.  Good CPR is really, really physical, especially for a petite little gal like me.  By this time, I am a nervous wreck.  I take Anne’s problems way too personally.

Normal Sinus Rhythm is a beautiful thing.

Normal Sinus Rhythm is a beautiful thing.

Next, my examiner gives me this scenario:  I’m in the operating room with a patient and her EKG shows a heart rate that suddenly goes from 68 to 135 and her blood pressure starts to drop.  This is the arrhythmia part of the test.  You know that nice normal EKG pattern we always see with a spike between two humps? That is called normal sinus rhythm and that is what we love to see on an EKG but Anne is such a drama queen.  She’s never in that rhythm for long.  There are a dozen or so aberrant rhythms that range from kind of ugly to downright terrifying.  Her current rhythm is somewhere in the middle and responds to a nice dose of Adenosine.  She converts to normal sinus rhythm.  Woo Hoo!   But there she goes again.  Fie on her.  I give her a second and larger dose of Adenosine which really works this time.  After Anne is conscious, I tell her that I will never, ever operate on her again and that she needs to find another plastic surgeon with larger cajones than mine.

And then my examiner raises the bar.  This time Anne has just walked into my office to get her tummy tuck stitches out and she goes to ground right in the middle of my really nice waiting room!  How rude.  I go through all the steps of CPR and get EKG monitoring set up  which shows normal sinus rhythm but Anne has no, nada, zero, zilch pulse.  So now while I’m doing CPR and getting an IV started and pushing epinephrine I have to figure out why it is that Anne’s heart has electrical activity but is not pumping blood.  There are about 12 reasons this can happen and I start with the most common in this scenario which is a pulmonary embolus (a blood clot to the lung).  Now, after some IV fluid and epinephrine,  Anne has a little bit of a blood pressure and I am ready to inset a breathing tube and get her over to Swedish Hospital for a diagnostic CAT scan and treatment and I’m about to have a cardiac arrest myself with my nurse examiner tells me that my exam is over and I passed!   WOO HOO!  I’m good for two more years and now I get to go change my scrubs which are soaked with sweat.  I really, really hope I never have to use these skills.  But I’m glad to keep up to date …..just in case.  I say goodbye to the examiner but not to Anne.  I may have a different examiner in two years but I know Anne will be back.  She always is.

Thanks for reading and if you don’t know CPR, get thee to a class.  The life you save my be of someone you love!  Dr. Lisa Lynn Sowder

 

Category: General Health, Patient Safety | Tags: , , , ,

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