Wednesday, December 03, 2008

Tamponade or if it weren't for Bad Luck....

Cardiac tamponade, also known as pericardial tamponade, is an emergency condition in which fluid accumulates in the pericardium (the sac in which the heart is enclosed). If the fluid significantly elevates the pressure on the heart it will prevent the heart's ventricles from filling properly. This in turn leads to a low stroke volume. The end result is ineffective pumping of blood, shock, and often death. (Sorry, no med porn here)

A concise definition from Wikipedia no less. Also what happened to me the week before Thanksgiving...

I went to have my cardiac ablation(look it up lay people) done and at the end of the procedure, the anesthesiologist noticed I didn't have a blood pressure. My Cardiologist did an ultrasound and quickly found the problem. He threaded a catheter into the pericardium and started draining blood. Soon he was auto-transfusing me to the tune of 4+ units of blood. They called the Clergy for my poor Love. And prepared to take me to the next OR to crack me open, when the bleeding slowed and I avoided that. Thank goodness for small favors..

Anyway, I spent the next 4 days in the ICU with a catheter in my heart and both a femoral venous and arterial line in my legs. Every few hours my doc would come in and drain the blood until it stopped bleeding. My cardiologist had perforated the left Atrium. The second time it had happened to him in like 7000 ablation procedures. At least I was NSR!

Until Monday. Went back in to AFib. Felt crappy again. Worked my shift Tuesday, then checked in to my own ED and had my guys electrocute me back to NSR.

My question is, do you guys think I've used up all my luck? Should I just lay in bed the rest of my life until death?? Should I file for welfare, disability, or some other way for YOU guys to pay for me to live??
Ahh fuck that..I gotta go back to work now. Last gang-banger only had 5 bullet holes yesterday. The wimp musta ducked..

Geez, don't you hate whiners?!!! OF


  1. I'm so glad you are ok! Scary stuff!

    I am beginning to feel the same way about just staying in bed and not tempting fate (or whatever) with the health stuff. Every time I think that this must be the last thing, something else comes up. I am guessing you are feeling sort of the same way. When I see the first star tonight, I'll wish for good health for both of us.

  2. You can't retire. If you did that, you would just sit around thinking about your problems. You need perforated gang-bangers to help you feel good about yourself.

  3. FFS Oldfart, how realistic is it to contemplate staying in bed until St Peter lets you in? Old sweats like you should keep going until you drop. Us Greenhorns need you to keep us in check!

  4. Luv ya Rad Girl and the rest of you guys..But my layoff must have dulled my sarcastic literary talent..
    I've no intention of laying down! Merely pointing out that bad shit happens to lots of folks and we don't look for somebody else to solve OUR problems!
    I've got patients to see..toodles

  5. Wow. Old Fart. You can't catch a break. Well, maybe you did. You keep surviving really crappy stuff. Here's to wishing you a happy holiday where you are NOT a patient.

    If I were funny, I'd say something really witty, right here.

  6. Maybe you should be Old Fart Cat with your nine lives and all.

    S. CAT

  7. Sounds like good timing to me Old Fart, before too long the only "Ablation" you'll be able to get will be Phenol treatments to your Nailbed to prevent those bothersome Ingrown Toenails, and it'll have to be done by an LPN and only after making it to the top of the 24 month waiting list.

  8. OldFart: You must have collected some serious karma in past lives to still be here. Must have been that busload of orphans that you saved or all those women you saved from lives of frustration. Or maybe you ust have friends and family that love you (-:
    I'm still praying, so you have to keep on recovering!


  9. Wow, that's all I can say. And you're back at work, giving 'em hell this week? More power to ya!

  10. Sounds like god hates you.

  11. That's mean, anon. Golden rule, dude.

  12. are like a lovely weed in the garden that Round Up doesn't kill!


    I am so glad you are still around to keep the youngins on their toes!

  13. Old Fart,
    If you do decide to lay down in bed and stay there, get some really good sheets, like satin sheets, that just feel really good on your skin.
    Oh, and don't forget beer and porn!

  14. OF,
    I choose to think this way: In "The World According to Garp" he says the house that has a plane hit it has been pre-disastered and therefore is now safe. So you have been pre-disastered for the rest of your life.

  15. Dil öğrenimi için başlıca merkezlerden biri olan Malta;
    İngilizce öğrenme sürecini Akdeniz' in kültürü ve harika doğal güzelliği ile birleştirmek isteyenler için ideal bir seçim.
    İngilizce adanın resmi dili ve heryerde konuşuluyor

  16. I thought only girls could get tamponade.

    And just to let you know old fart, I would TOTALLY pay for you to spend the rest of your days in bed. Not because you're ill, but because I've heard that you are the most handsome of all the MDOD docs. But, I should probably let you know up front that we'd most likely only be able to eat ramen noodles most of the time and we could only watch channels 2, 5, 7, 9, and occasionally 12. But it could be fun, huh?? Like camping!

  17. I thought only girls could get tamponade.

    And just to let you know old fart, I would TOTALLY pay for you to spend the rest of your days in bed. Not because you're ill, but because I've heard that you are the most handsome of all the MDOD docs. But, I should probably let you know up front that we'd most likely only be able to eat ramen noodles most of the time and we could only watch channels 2, 5, 7, 9, and occasionally 12. But it could be fun, huh?? Like camping!

  18. You have indeed used a lot of luck lately. Next time you venture to Las Vegas, spend time looking at the pretty naked ladies, rather than at the tables.

    Best of luck to you and your family

  19. Dadgummit, Farty! You're not allowed to scare us like that. What shocks the crap out of me is that you went to work. What a tough cuss you are. Me? I'd have slunk my sorry butt into bed and pulled the covers over my eyes. I'm wishing on stars, too, big guy. Big hugs to ya.

  20. Yikes. Near death, and you can still joke about it. Now that's transcendence!

  21. Question.

    I know how scary it can be getting online researching symptoms when trying to decide to go to the Doctor. I recently freaked due to this plus some of my EM Doc Friends were like "Go see your PCP, idiot, it could be serious"

    That actually scared me more.

    But, when something medically scary happens to you, what is it like? Being a Doc you're obviously gonna have a better idea of what's going on. Does that comfort or scare you?

    On a somewhat un-related note I know a Doc who did his residency in GS, but spent most of his time in the ED so he's Grandfathered into the boards who said, "I HATE treating MD's, the weirdest, rarest and most serious complications happen when you're working on a MD!"

  22. Don't stop, don't slow down, if you don't want to. Do what you want to do. Life is too short to be unhappy. But, as an ED doc, I suspect you know that.
    BTW, I diagnosed a tamponade in the field with the same cause as yours.
    Once I got him to the ED, I told the doc (now my physican advisor) what I suspected. He poo-pooed the idea.
    Several hours later when I returned to the hospital, they were preparing him for an out-of-town transport. The doc (very grudgingly) acknowledged that yes, he had a tamponade. That's the only time he was ever wrong to my knowledge.

  23. Hey, I think you were a question on my Anesthesia Boards...Perfect case for IV ketamine, patient gets to stay awake, could even see the surgeon monkeying around with his heart if it wasn't for the drapes. Its the one situation where the standard recipe of Pentothal/Tube/Positive Pressure Ventilation ends up with 7 figure malpractice award...

  24. I read about a couple of hot young nurses aides in Minnesota who are looking for work.

  25. Greta..It's true

    Dev..Love ya Keep the prayers coming

    SBJ..I wondered when somebody would ask that question. It's not as scary as I thought. It's tougher on my Love and Family.
    I did tell the Anesthesiologist that day that I was a dr so you know anything that can go wrong will(joking)
    I thought it might change how I practiced medicine, saw people, interacted etc..So far probably not but I will keep you updated!

  26. Hey Scapel.Send contact info on those nurses aides!! :-)

  27. Talk about some bad ju ju. I will keep you in my thoughts and prayers.

    Cynical Bastard

  28. This comment has been removed by the author.

  29. I remember thinking "WTF?" when I was about 10 years old, enrolled in vacation bible school. I read that King David kept a virgin in bed with him to keep him warm in his old age. Did he have to rotate them out, I wondered? Your wife probably won't go for it, but you can give it a shot.

  30. I'm hardly panglossian, but hey, you're still alive & kicking! Sounds like you've not only cheated Death, but also stole his credit card, and used it to buy "male enhancement" pills online so that you could place them in the Reaper's office for his co-workers to find. Nice job stayin' alive.

    Also, I love the links to wikipedia's entries for "emergency" and "heart." Ahhh, the quiet ironies of excellent writing. I couldn't find "acute lack of free goods & services" on that wiki page though, you may need to modify it for the huddled masses yearning for free ______. I'm glad that you archive these posts because M.D.O.D.'s delicate subtleties oft' escape me. I'll come back & read your posts in a few dozen years, when I'm truly ready for the teachings of OldFart. Blinded by youth.


  31. Ruby

    Loved the comment on death.

    Whenever someone in my family sees the doctor, I usually don't tell them up front that I am a doc, (1) so as to not skew their judgement and (2) to see how they care for the average Joe. Then I eventually do tell them.


  32. Not that it is the appropriate answer for you, but do you have Disability Insurance? Given the "you-never-know"s of life -- taken in concert with your unusual concern about the sucking wound your monthly pay off would likely create in the nation's barely kicking budget -- that might be the honorable path.

    Except that you are not going to need it. You've plenty of luck and generic gumption in store. Think healing thoughts and stop
    crying out "be still my heart!" everytime you see your Love...

    Some people will try to foist upon you the notion that some Higher Power (or any other Moral Master requiring capitalization) is either:
    A. not done with you ("you all iz a work in progress! He ain't done with you all yet!") or
    2. has plans for you that you've not yet fulfilled (No, that is NOT the same as option A!). This is more like a sci-fi take on things. Your current Tiny Troubles are actually the missteps of some wanker from the future who has come back to try and change stuff. Don't worry, he'll get his! You follow? God bless the Prime Directive!

    Feel better -- or be well, your choice!

  33. OF -
    Sorry to hear of the ablation woes.
    You could challenge more of those lives and take amiodarone and get zapped again if afib w/ RVR recurs.
    Best of luck.

    PS, BTW, being the EP RN when someone perfs the RV with an ablation catheter is no fun either!
    This preceeded the current days of having anesthesia involved and EP RNs did "conscious sedation". When the pt expresses that sense of impending doom you know things are baaaddd.

  34. Every once in awhile, one of our OldFart docs'll reluctantly come down from the admin offices and go into a resuscitation room in septic shock or in afib with RVR or whatever (literally on both). We think he's gonna die then he's back at work the next week like nothing happened.

    Like fuckin' A, the paperwork can wait, man.

    PS That guy is cool. Nary a bad word has been uttered about him on my blog.

  35. Thanks RR, wish I was half as smart as you think!..

    CardioNP, I was, and am, on Amio..Back in AFib again too..I have to teach tomorrow, so in between lectures I'll go down and get myself zapped if I have time!!

    Dev, They are just "nurse's aides" My Love is a nurse.

    Bianca, I don't have disability insur..Don't ask, other than I was previously immortal, and it cost too much! And we probably don't have much to talk about since you don't believe in I Am..OF

  36. A few DAYS off might not be a bad idea after that. Yeesh, dedication to the job and all that.

    Glad your obnoxious self is still here, and hope to be irritated by your writings for many years to come.

    With love from a longtime reader and bleeding heart (figuratively, not literally like yours) liberal.

  37. Moi, I will not be rebuffed by your evident clericalism, O Elder Stinkbomb! In fact, G_d has deigned to sic a virginal vision on La Belle et Bonne Bianca Castafiore, one that urges me to urge you to visit The Sanctified Scanman, and to heed his Holy Message, as it was meant for no one less than you:

    Just joshing. I hope you have a better week, and then a better one after that. And so on!

  38. How are you doing, OF?