Week Three of Immersion

This week was pretty interesting overall. One of the first things I saw was with Greg Fedorchak. We witnessed a 1 year old male being transferred from cardiac surgery to the pediatric intensive care unit. He had just had surgery trying to fix his several heart conditions, including Tetrology of Fallot (ToF). However, several things were going wrong right from the get go. The patient was losing quite a lot of blood from the wounds induced from the surgery, his blood pressure was way too low (50/25), and they were having problems with his breathing, as well as having problems getting his IV lines up and running to administer the proper drugs. In the end, they only had one subcutaneous IV working so they had to perform emergency surgery on the hospital bed to open up another IV line in his femoral artery. They called this a "central line," since it has better blood flow, but it is harder to get to and is generally a more desperate attempt to administer treatments, as well as carries extensive bleeding risks. In the end, this attempt worked, so they were able to better monitor and administer treatments to help this kid survive. While this was all happening, several nurses were desperately giving the kid morphine and other drugs to keep him sedated as well as try to reduce his heart rate (about 200 bpm) and increase his blood pressure. The nurses had to go through several hundred cc's of frozen fresh plasma (FFP), platelets to help stop the bleeding, as well as administer saline through one of the IVs. They also had the kid hooked up to a ventilator to prevent labored breathing, but even this had its problems. In the end, the kid was stabilized in about 24 hours. The increase in fluid intake helped increase his blood pressure enough so that his heart could calm down.

I also went to the PICU this week, and it was sad to see so many sick children, but it seems like they were all in better shape than the previously mentioned kid was in the other day. One of the interesting cases was when I heard about Maple Syrup Urine disease, which is a very rare disease where the body is not able to process a couple amino acids, which leads to many problems down the line. The doctors said that there is not much they could do to help the kid, other than keep her diet restricted as well as give her medications to help prevent her body from building up too many of these amino acids (which apparently is hard).

Other than that, I shadowed my mentor, Dr Goodman, around to see some of her patients this week because she is finally back from her conference/vacation. She allowed me to see some of her private patients this week and it was very cool seeing her see many patients. Overall, none of the cases really stood out. Also, we are getting the research project underway. I am currently looking into see how methotrexate affects the pathology of hip replacement patients with RA (and potentially OA as well). I am going to be learning about the pathology of these samples as well as other factors that could contribute to the study (more details to come).