Posted on 04/04/2007 10:15:22 PM PDT by 60Gunner
In my last post, I described my encounter with a patient who was diagnosed with an aortic dissection and whisked away by airlift to a Super-Hospital for treatment. Due to the demand of all and sundry who have threatened to lynch me if I did not tell the rest of the story, here is the rest of the story, as far as I know it.
The patient faced a truly brutal and frightening surgery. I had it described to me by a nurse who has sat in in one, and here is my best attempt to relate it. Anyone out there who knows more, feel free to correct me because this is all brand-new turf for me. But here is the bare-bones version.
The patient's body temperature is cooled down to 60 degrees- at which point the brain is nearly completely inactive. The patient is then nearly completely exsanguinated in order to reduce the risk of a high-pressure bleedout when the aorta is disrupted. The affected section of the aorta is resected, and a large-bore graft made of synthetic material is carefully and meticulously sewn in. Once the grafting is complete, circulation is slowly restored, while the graft is watched for any sign of a leak. If no leak is found and the patient stabilizes sufficiently, he is closed up and taken to intensive care for monitoring.
Fifty percent of the patients who undergo the procedure die on the table. Of the survivors, a majority end up with renal failure and spend the rest of their lives on dialysis or looking for a kidney transplant. Many suffer brain damage of varying degrees. Some suffer catastrophic embolisms, strokes, and heart attacks. The other side of the surgery is not a pretty picture, unfortunately.
The patient in question made it through surgery. I am told that he did exceptionally well, that although he came out of it all just a little on the "goofy" side, that seems to be resolving. His kidneys were a little slow to get going again, but his creatinine is almost normal. He doesn't remember what happened, and he doesn't remember me (just as well, since I shoved a couple of big-arsed bus tunnels into his arms). His family is doing well.
But he's alive and doing well according to my most recent follow-up. You can all breathe again.
Nurse Dynamite is doing fine, too. She said she held her breath for the entire flight. When she says something is scary, you can bet on it.
ER NUrsing Stories Happy Ending Ping!
Thanks. Now I can go to bed.
8-)
Thanks for sharing this, remind me never to suffer from an aortic dissection.
Cheers!
Thanks for letting us know! I’m so glad for him and his family!
Phew! Thanks!
maybe I wasn’t looking at death then (my post attempting to interpret the pic at the other thread) but just bad luck. Then again maybe I was and this fellow has for the time being merely cheated it.
As always, another great story, Gunner. I’m glad he made it, I know the chances were not good.
Sorry I missed part one. Sounds sorta like what happened to the wife’s co-worker - accidental bisection of a coronary artery during an angiogram.
The lady had two heart attacks during the recovery at Tucson Medical Center.
I don’t recall her going through what you described above, but that may be because her surgeon opened up a smaller artery.
She’s doing just fine now, about 8 months later.
He’s lucky he made it.
Comedian John Ritter died of Aortic dissection. I’ve never seen a case, probably because we don’t diagnose it in time to fix it...
An aside; there are credible reports of a significant number of such aortic dissections caused by airbag deployment — the unsupported aortic arch in human history was never subjected to such high G’s... in a survivable situation—
Interesting topic. Never heard of it. Thanks to all contributors.
You wereright on both counts. You were looking at death, and he cheated it.
I'll let you in on something else: the week before this guy came in, we had another case. Only that fellow didn't make it. His dissection blew out on the CT table. We got images of it in progress (it happened too fast for us to stop the scan). One second, he was fine; the next picture showed a belly full of blood with more pouring out of the hole. The images were just awful.
It was fortuitous for my patient that the MD for the deceased patient was also my patient's MD: He was hypervigilant, and the pale right leg fired him up. He's a helluva doctor.
Apparently John Ritter had no history of heart problems whatsoever. But that day, while he was at the studio practically across the street from the hospital, he had some chest pain which radiated to his back.
They got him to the ER fairly quickly; but my impression is that by the time they figured out what was wrong, he was dead. It certainly wasn't the fault of the doctors there, but I wouldn't be surprised if his widow sued them anyway.
I’m glad he made it! Thank you for posting the follow up, what a scary story. You and your team (as well as the transport team and surgical team) did a great job!
My brother in law had this almost two years ago. Woke up with serious back pain, went to the very small town hospital nearby. They knew something was wrong but could not diagnose it. They flew him by helicopter to a hospital two hours away where they diagnosed him, stabilized him, and did the surgery. He was able to travel six weeks later across the country to attend my dad’s memorial service. Amazing. His doctor said it was a miracle that he survived the trip between hospitals.
Wow.... that’s one hell of a story. Glad he made it through. Lucky for him you knew what you were looking at.
You can find it here.
http://www.freerepublic.com/focus/f-news/1812250/posts
Here’s my favorite Emergency Nursing story!
http://www.freerepublic.com/focus/f-news/1733043/posts
If you ask 60gunner nicely he might add you to his ping list!
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