Cardiac Cath Lab rotations.

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Mattyirie

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Just got done spending a morning in the cath lab at one of the local hospitals here in town! This program was created by the service I work for and the hospital educational director. Two cases, both exploratory and neither required intervention. The first case was an older male complaining of chest pain and they just wanted to see what was going on I guess. Second case was an investigation of the coronary and cerebral vasculature and again nothing of concern. FRICKEN awesome! I brought my A&P text and blew my mind pretty much. The cardiologist used various catheters to measure FFR in different areas checking for aortic valve abnormalities. It was so cool to see pressures change in seconds! While in the left ventricle, the catheter caused a run of PVC's from irritation haha. Pretty cool to see actual rhythm changes on ECG. The program also includes a portion where we can run a chest pain/STEMI and upon arrival at the ER we can follow the patient straight into the cath lab (system status dependent of course) bypassing the ER completely if proper 12-lead transmission occurs and all that.

On a similar note I have been thinking lately how beneficial it would be to somehow easily, securely and reliably check on a particular patient's progression of care to discharge. I think it would benefit pre-hospital providers immensely to see how their initial impression in the field checked out. I always wonder, did that patient really have what i think they had? Did so and so make it? At this point we have to question the right people and ask around and alot of times i end up at a dead end.

what kind of cool educational programs does your system employ?
 
We also have the ability to follow patients to the cath lab, if we choose. We are able to activate the lab from the field, without transmission. Most times we stop in the ED for a moment or two...

We also have almost unlimited OR opportunity for intubations and our medics take advantage of it. We've just started a pedi intubation rotation, so all of our medics have opportunity to intubate some kids and talk to the anesthesiologist about pediatric airway difficulties. That's something that few services offer.
 
I spent a few shifts in the cath lab, it was a fantastic learning experience. One of the patients was in cardiogenic shock and got an IABP placed.
 
Very cool!

Our service doesn't have OR rotations yet but this is being worked thru, not that this benefits me any at this time. I don't think transmission of the ECG is required (i am new to my service and to EMS) but it is appreciated. This may also be the reason we would be able to bypass ED in most cases?

@n7lxi: What are door to balloon times in your area? you mentioned you stop in ED which is the case sometimes here but if obvious STEMI coming in then the patient goes from gurney to table. Our hospitals aim for between 70-90 minutes.
 
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At my hospital you can file a request for follow up on a patient. You just email this address with the record number of the case.
 
Did you actually get to be in the room while they did the cath or were you behind glass? The program I'm in has cath lab clinicals and I have no idea how they work. We also will have OR, psych, and pedi shifts. I'm looking forward to all of it.
 
bigbaldguy said:
Did you actually get to be in the room while they did the cath or were you behind glass? The program I'm in has cath lab clinicals and I have no idea how they work. We also will have OR, psych, and pedi shifts. I'm looking forward to all of it.
Click to expand...

I was able to sterile scrub in and be table side a few times. Others wanted me behind the glass. Depends on the doctor and the nurses performing the procedure.
 
Same here. If we bring in a patient from the field, we're behind the glass. I was allowed to scrub in a few times with a cardiologist back home in Washington and he was very interested in teaching. He thought every paramedic would benefit from being table size and seeing the process from field to the cath lab.

You know, I don't know the current door to balloon average here. It's funny, usually that's something a system brags on. An old (2011) report said the median door to balloon time at the primary hospital we use for PCI was 59 minutes...
 
I did not get the opportunity to scrub in. I was behind the glass. I am not sure how much different it is being at the pt's side as the tangible portion of the procedure is much like a PICC line placement which i have been directly involved in many times. I am ok being behind the glass and learned plenty for a first time thru.
 
We are able to schedule time to go observe catheterizations while off duty. It's not practical for us to follow the patient all the way to the lab while on duty.

Our main PCI center's median door to PCI time with an EMS pre-alert is under 60 minutes. They said it in our CQI meeting yesterday but I can't remember if it was 59 or 54. They are tweaking the system and aiming towards sub 30 minute times. We make it happen in under 30 minutes plenty but not consistently. They are having us draw labs in the field now for STEMIs going to this facility, I'm sure next they'll be asking us to shave them as well hah. Also we don't transmit 12-leads. Activations of the hospitals' STEMI protocols are the medic's responsibility.
 
Wow. Its good to gain some perspective. We are behind the curve out here. But to be reasonable we are a smaller area with cardiologists on call part of the time.
 
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