By allied health world contributing writer
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A male patient in his late 50s gets admitted to the Emergency Department with the complaint of severe chest pain. "It's like an elephant is sitting on my chest," the patient, who is sweating profusely, says to describe his severe chest pressure. He suddenly becomes overcome with a severe bout of nausea and vomiting. The Emergency Department staff work quickly to treat the patient, suspecting a possible heart attack. The patient is placed on oxygen, an IV is started, and an EKG is ordered. The 12-lead EKG confirms their suspicion that the patient is experiencing a heart attack. The cardiologist and cath lab team are immediately paged to report to the hospital for an emergent heart cath.
When the cath team arrives at the hospital, part of the team responds to the Emergency Department to assist in transferring the patient while the rest of the team prepares the room and needed supplies. Everyone works quickly as a team in what appears to be well-choreographed movements. Each person knows their role and quickly performs it so as to not waste precious time. Every minute that a coronary artery remains blocked means death to heart tissue, hence the slogan "Time is Muscle".
The patient is placed on the procedure table but due to the severe pain he finds it very difficult to lay still. The cath lab "circulator" administers pain medication to the patient in an effort to relieve his discomfort. The three nitroglycerin tablets placed under the tongue do little to relieve the pain and the patient continues to cry out in pain. As the cath lab "scrub" technologist and "circulator" cover the patient with a sterile drape in preparation for the procedure, the cath lab "recorder" calls out from the control room "He's in V Fib!" All eyes in the room instinctively turn to the monitor, which, in deed, shows the chaotic, non-perfusing heart rhythm known as ventricular fibrillation. The circulator dashes to the defibrillator, kept within arms’ reach of the procedure table, pulls back the sterile drape, and charges the paddles for defibrillation. "Clear" the circulator calls out loudly as she places the paddles on the chest of the patient. "Clear" is repeated back by others in the room. THWACK!! The patient's body jerks as the energy from the defibrillator courses through the body in an attempt to restart the patient's heart. "Check for a pulse," the recorder calls out as he observes a stabilized heart rate on the monitor.
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Everyone in the room now has a heightened sense of awareness as they proceed with the case knowing this could happen again. The physician gains arterial access through the large femoral artery in the groin and advances a catheter to the heart using x-ray to follow the path the catheter takes through the patient's body. Contrast dye is injected into the coronary artery while being digitally recorded on the x-ray system.
"Totally occluded LAD" the cardiologist calls out indicating a blocked left anterior descending artery that supplies blood to a major portion of the heart. This is followed by multiple orders from the cardiologist for medication and equipment. "V Fib,"calls out the recorder as the each staff member is busy preparing the additional equipment and medications. Everyone drops what they are doing and the patient is once again defibrillated successfully. The cardiologist advances a small guidewire through the catheter out into the coronary artery, passing through the blockage. Small "puffs" of contrast are injected into the artery under x-ray to ensure the guidewire is advanced to the desired location. A small balloon catheter is then advanced over the guidewire and positioned at the point of the blockage. "Going up," the scrub person calls out indicating he is now inflating the balloon. All eyes watch the monitor in anticipation of another episode of ventricular fibrillation. The balloon is deflated and a quick injection of contrast under x-ray confirms that blood flow has been restored to the heart muscle and that the artery is opened.
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The patient's EKG shows improvement over the next few minutes as the heart attack has been relieved, and the color returns to his face, which was previously an ashen grey. The procedure continues without incident as a stent is placed at the site of the blockage to help hold the artery open. As the patient is being removed from the procedure table onto a transport gurney he says to the cardiovascular medical staff, "Thank you so much, I feel 100% better". A knowing look passes between members of the Cath Lab team. This is why cardiovascular technologists are a part of this exciting and life-saving field.
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