Ask the Clinical Instructor

We did a bypass study of the RCA. It was bypassed by a RIMA. The cathing physician said it could also be bypassed by an artery from the stomach. What did he mean? The physician was referring to the gastroepiploic artery. The gastroepiploic artery feeds the stomach and can be, though it is not frequently, used. It can be freed from the stomach and moved through the diaphragm and grafted onto the heart’s native artery. To get an angiographic view of the graft, cannulation of an independent branch of the descending aorta is necessary. During coronary angiography, one of the patients we had went asystolic. Why was that? Occasionally, during angiography, patients may go asystolic because the sinus node has been interrupted. If the sinus node can't send a signal, the result is asystole. When this happens it is important, if you have not already, to tell the patient to listen for you to say cough. If coughing doesn't resolve the asystole, which many times in my experience it usually does, CPR may be necessary. Prophylactic atropine may also be given at the physician’s direction. This will let the heart go faster by suppressing the vagus nerve’s activity. The following injections will likely produce either slower sinus rates or junctional rhythms if the sinus node is still being blocked. Remember to always watch the motor during the injection. I am a second year ICT student. Starting last summer quarter, I have done clinical work at three hospitals and one private clinic. For myself, the best experience was where I had a mentor to work with me. This did not mean that person scrubbed every case with me, rather he was someone who could keep me moving along as I progressed. At the other hospitals I have gone to for clinical training, the student is left to work with whatever tech will work with you. The problem I am having is that if you work with ten techs, you find ten different ways of doing the same thing. This can be frustrating to both the students and the techs (more so for the student). I think it would be easier on the hospital crew and a better experience for the student if all hospitals could find a few good techs to work with each group of students. I know where you are coming from. I, along with most other former and current students, have gone through the same thing. Ideally, one mentor to one student would work best. This, however, doesn't always work, even with my student. What I would suggest is to take it as a challenge to learn as much as you can from each person. When you get to your job after school, the same thing will happen with the physicians, because they have their own preferences. Also, working with all of the different techs, you can take what you like best from each of them. For myself, it got to the point where I had to say to my mentors, if it's a right and wrong thing, please tell me, if it's a preference, please let me do it my way so I can develop a style and become proficient at it. They were more accommodating after that. Hope this helps. Contact Jason Wilson with your questions at: hrtfixr7@yahoo.com

NULL