Weeks 50 & 51: The Resuscitation

I, and three of my other classmates, stood beside our ‘patient’ (a mannequin simulating a real patient), and prepared for our practical assessment, which we would all have to pass to acquire our advanced cardiac life support certifications. Rotating as team leaders we would each have to lead each other through the resuscitation of a patient undergoing a cardiac arrest, with each team member performing a specific task (providing ventilation/intubation, chest compressions, and/or administering intravenous medications). The instructor informed me to assume my position as team leader, and my practical began…

My patient was an elderly male, presenting to the emergency department with chest palpitations. The instructor held an iPad, which displayed all of the patient’s vital signs and his EKG rhythm. There was also settings available if/when it became necessary to defibrillate/cardiovert (reset the heart rhythm) the patient. My patient initially presented with atrial flutter (a rapid, abnormal heart rhythm), so I initially instructed my team members to administer the appropriate medication in an attempt to slow the rhythm. Unfortunately, the treatment of this patient was not as simple and quick as giving a single dose of medication. Before I completed my practical, this same patient experienced a myriad of other rapid, abnormal heart rhythms, lost his pulse a couple of times, and then finally after chest compressions, air delivery, medication pushes, and several rounds of re-setting his heart rhythm (with shocks), the patient revived and his vital signs stabilized. It was a long five minutes, but it was such a cool simulation…

Over two Saturday sessions, nine hours each, my classmates and I attained our advanced cardiac life support certifications, which we needed prior to starting rotations. We all received our basic life support certification (CPR) prior to beginning PA school, but advanced life support adds medication use, EKG monitoring, and more invasive methods of breathing aid (intubation) to the mix. As described above, at the end of the course, each of us had to demonstrate that we could lead a team through the resuscitation of a “pulseless” patient with the information we learned. I always marveled (and still do!) at dramatic scenes of medical TV shows, especially at how the clinicians know exactly what instructions to give, equipment to use, and medication doses to prepare, in an attempt to revive a patient. It was just so surreal to be given the task of performing similar actions in this setting.

Aside from the extra weekend time spent at school, we covered a lot (what else is new?) of new information in each course. In Emergency Medicine, we focused on the treatment of infectious disease emergencies (fever, meningitis, skin infections, HIV exacerbation and associated infections), as well as OB/GYN and reproductive emergencies (testicular torsion, ectopic pregnancy, emergency delivery…etc.). In Family Practice, we focused on outpatient treatment of diabetes and thyroid disease. In Pediatrics, we continued to focus on infections that can occur throughout infancy, in addition to genetic syndromes (Down syndrome, Turner syndrome, Marfan syndrome…etc.). In Pathology, we focused on the causes and derivations of cardiovascular and respiratory disease states. Finally, in Clinical Skills, we learned how to perform arterial blood draws (used mainly for assessing oxygen and carbon dioxide levels). We did not practice this on each other, as we did for drawing blood from veins, because this procedure is a bit more painful, and also has an increased risk of bleeding (since the blood within arteries is of a higher pressure relative to veins). Instead, we practiced on arm simulators with fake blood and pulses.

Already six weeks of the semester are down! Midterms are right around the corner…

Question of the week: You just completed an arterial blood draw on your patient. After withdrawing the needle from the artery, approximately how long should you apply pressure over the puncture site? 30 seconds, 10 minutes, or 45 minutes

Last week’s answer: You just received an injection of your annual influenza vaccination. This injection was an intramuscular one.

Clinical Phase Countdown: 93 days

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