My Time Shadowing

This Friday, September 29th, I had my second clinical observation experience in the Cardiac Cath Lab. I was there from 7:00 a.m. till noon, viewing the flow and duties of the nursing staff on the unit, learning about the procedures done on this specialized unit. Throughout most of the morning I followed Sara, an RN, who had been in the unit for eight years. It was an impressive experience that broadened my previously limited knowledge of the roles and experience of a Cath Lab nurse.

The stent will be placed where it can be expanded to hold the artery open. Some stents are designed to simply keep the artery held open. Other stents used are drug-eluting stents. These stents are coated with pharmacologic agents that work to prevent restenosis of the artery.

Having the opportunity to shadowing in primary care practices was most profound to my introduction of the practice of clinical medicine. It was through observing patient interactions centered upon the diagnosis and treatment of common medical conditions that I was able utilize medical information I had learned as an undergraduate to the actual application of practicing medicine. For instance, information about diabetes mellitus learned from my anatomy and physiology course was transformed into the physically diagnosis, treatment, and long-term management of the chronic condition in medical settings. Thus, shadowing in such a practice truly brought medicine to life for me. Likewise, while shadowing, I had the opportunity to listen to patients

I shadowed Dr. Martin Skie at the University of Toledo Medical Center when I started contemplating a career as a physician. He is an orthopedic surgeon and I had the privilege to shadow during several surgeries, and throughout clinical rotations. I spent over fifty hours shadowing him over the course of a month. I also had the opportunity to shadow Dr. Zachary Ginsberg, an intensivist, in Kettering Medical Center’s intensive care unit. I was able to discuss the patients, their conditions, the lab results, imaging studies, medications, procedures, and the science behind the thought process while shadowing for over one hundred hours over several months. Both opportunities provided insight into different specialties and sparked my interest.Since

DAPT had to have long enough time after implanting the stent into arteries to prevent stent thrombosis.Premature discontinuation of anticoagulation therapy, also known as premature discontinuation of DAPT, means discontinuation of DAPT for less than three months for sirolimus-eluting stents (SES) and shorter than six months for paclitaxel-eluting stents (PES). The outcome of the premature discontinuation of DAPT can increase the risk of stent thrombosis, myocardial infarction, and death. Bare-metal stents (BMS) do not relate to blood clotting issues after stent implantation such as stent thrombosis. Therefore, it can be said that BMS do not need anti-clotting therapies. On the contrary, drug-eluting stents have been involved with late stent thrombosis. To prevent this issue, optimal conditions of several factors should be considered. Those factors can be stent position and expansion, the number of stents, stent size, stent design, patient and lesion, and premature discontinuation of antiplatelet medicines. Revascularization can be defined that produce the healthy blood circulation to a body part again under the situation carrying depletion of oxygen to an organ. The terminology, revascularization, is usually used by surgical

Manipulating the transducer to obtain an optimal angle of incidence is important. Sub-xiphoid, subcostal and intercostal views are all potentially used to align the beam with the vessel of interest. Stent material is easily seen using two-dimensional ultrasound. “Shadowing is only a problem when stents covered with fabric such as polytetrafluoroethylene are used. In these cases, gas that is embedded in the fabric will cause shadowing for several days, but eventually the gas is absorbed and the covered stents then appear similar to conventional stents.”8 Middleton, Teefey and Darcy8 note that the use of PFTE endografts will likely become standard as their performance outweighs the early stent materials used. Color Doppler as well as pulsed Doppler should be used to interrogate the stent and supporting vessels. Velocity measurements are taken using angle correct and spectral waveforms are recorded. Careful examination of the liver vasculature is imperative to verify proper stent function. Specifically, thrombosis or occlusion can be assessed with color and Doppler ultrasound. Velocity parameters may vary from patient to patient and also will change from immediate post procedure velocities to those obtained during long term follow up. Universal Doppler criteria has not been established as of yet, although some physicians and facilities have developed

Airway stents are designed to restore airway patency and to mimic normal airway anatomy and physiology by their simple hollow tube design which comes in many different sizes and materials. They help improve the pulmonary functions of patients who suffer from central airway obstruction by maximizing ventilation and oxygenation in the narrowed airways. Airway stents can be either permanent or a temporary mechanism which can be removed once the underlying airway disease has been treated. They can be placed in either the trachea or the bronchi depending on where the narrowed portion of the airway is located. A computerized tomography scan (CT) is used to determine which type of airway stent is best suitable for each patient. Airway stents are

1. Angioplasty: Kereiakes and Wetherill write that “angioplasty is a procedure in which a heart doctor inserts a balloon catheter over a thin wire across an artery. The balloon is inflated and compresses the plaque to clear the arteries of any blockage.”(p. 106-107).

I had previously shadowed 3 other doctors, but nothing was like my time spent with Dr. Sastry. I had the unique opportunity of being both his patient and his shadow. From the moment I stepped foot into the office in 2013 as a patient, he infused my mind with his infectious spirit of medicine and the beauty of healing. He made me feel very comfortable, and I was very grateful for the fact that he cared so much. I was always drawn to the healthcare field, but I didn’t know who to go to for the abundant amount of questions I had in becoming a physician. Due to his affable and invigorating personality, I knew I wanted to shadow him because I believed that there probably isn’t a better physician and mentor who retains such an optimistic view of life and medicine.

The purpose of this journal is to reflect on my experience and skills gained during my clinical placement at Ben Taub Hospital. On my first clinical day, I was excited and nervous at the same time. My first placement was in the PREOP/PACU area. I was assigned to help a patient who had been in the PACU area going on 2 days. Normally, once the patient comes from surgery they are only in the PACU area for a short period of time before they are discharged home or given a bed in another area of the hospital. This particular patient still had not received an assignment for a bed. The physicians would make their rounds to come check on him daily. The patient was a 28-year-old Hispanic male, non-English speaking, he had a hemicolectomy. He had a NG tube, urinary Foley catheter, and a wound vac. My preceptor had just clocked in and she needed to check on the patient’s vitals and notes from the previous nurse. Once she introduced me to the patient and explained while I was there, she then asked me to check his vitals. (Vital signs indicate the body’s ability to regulate body temperature, maintain blood flow, and oxygenate body tissues. Vital signs are important indicators of a client’s overall health status (Hogan, 2014). I froze for a quick second. I have practiced taking vitals numerous of times and I knew I could do it correctly. I started with the temperature first, when I was quickly corrected on a major mistake I had made by my preceptor. I HAD FORGOT TO WASH MY HANDS and PUT

The guy was dealing with Morton’s neuroma and essentially a pebble like growth had formed and had to be removed, due to the painful “gravel-like” feeling a person would get when dealing with it. We also talked about his total knee surgery and that process which was super interesting. The actual reason the guy was there though, was to fix some shoulder pain. Noah got him healed up in no time with some band exercises and an ultrasound. The last guy who came in was someone I’d met before who had injured his knee. He’d been in a couple times between the last time I’d seen him, and wasn’t really responding to the treatment. Noah explained that it happens, and recommended that the guy see/do something else as the PT wasn’t effective. If I were Noah, I would’ve been pretty bummed out to have tried all my stuff, but still being unable to help someone. He didn’t seem shook at all though, and I really admired his humility and understanding that sometimes PT doesn’t always work. It’s something that I hope I can apply to my own life. Overall I’m incredibly grateful for my shadowing experience. I honestly wasn’t really sure what to expect when I started, but it was a really fun process due to the people working, and the stuff I learned during my

The ideal purpose of implant is to do the defined task and then dematerialize. The same is expected for the stents inserted in the heart vessels. But unfortunately the conventional stents stays in the body leading to unwanted side effects. Considering advancements from metal stents to present drug eluting stents the ultimate bioabsorbable stent is not yet achievable. With development of such a stent the need of antiplatelet drug will not exist and a person would not have to move around with metal in their body. The ultimate goal of the bioresorbable stent will be leaving the vessels regenerated, resulting in restored functioning. The advantage of the bioabsorbable stent is that if in future there is a need of bypass surgery then the stent would

According to world statistics, there are 9.4 million deaths each year caused by cardiovascular disease and 45% of these deaths are caused by coronary heart disease [1]. Stent installation is a much-chosen alternative because it does not require surgery, has a lower risk of complications, and faster installation and healing times than bypass, and is more effective at preventing restenosis [2]. Moreover, since it was first developed in the 1980s, there are more than 100 coronary stents that have been marketed and evaluated worldwide [3]. The total number of stent requests in 2012 in 3 major hospitals in Indonesia reaches 4000 stents [4], even according to Global coronary stents market is expected to reach USD 6.4 billion by 2024 from USD 5.3

appear similar to conventional stents.”8 Middleton, Teefey and Darcy8 note that the use of PFTE endografts will likely become standard as their performance outweighs the early stent materials used. Color Doppler as well as pulsed Doppler should be used to interrogate the stent and supporting vessels. Velocity measurements are taken using angle correct and spectral waveforms are recorded. Careful examination of the liver vasculature is imperative to verify proper stent function. Specifically, thrombosis or occlusion can be assessed with color and Doppler ultrasound. Velocity parameters may vary from patient to patient and also will change from immediate post procedure velocities to those obtained during long term follow up. Universal Doppler

Since the late eighties, stenting has been the primary means of treating stenosed passageways within the body. This started with self-expanding bare metal stents; however, these stents could eventually lead to restenosis of vessels. In the Gastrointestinal system in particular, these stents tend to migrate and are difficult to remove at a later date. Though stenting in the GI system with these methods initially treated the pathologies, they could lead to additional cost and stress to the patient later on. With the recent development of biodegradable stents, this problem could be eliminated. With the use of biodegradable materials or biomaterials in stenting, the complications from metal of even plastic stenting could be eliminated due to