My first open-heart case...words of wisdom?

  1. I'll be in my first open-heart case tomorrow. Any words of wisdom or tid-bits/tips from those of you who have been through it?

    Thanks in advance!
  2. Visit MaleAPRN profile page

    About MaleAPRN

    Joined: Feb '04; Posts: 218; Likes: 17
    ICU RN / ER NP - resigned to go to CRNA school in Aug.
    Specialty: Nurse Practitioner/CRNA Pain Mgmt

    7 Comments

  3. by   gaspassah
    get there early, you got about 8 drips to mix plus syringes of all sorts of stuff.
    listen carefully while on bypass, the surgeon will whisper table up or turn to me, then a little louder, then he'll yell, I SAID TURN THE TABLE!!! as everyone in the OR looks at you like your crazy.
    learn the steps to putting in swanz and the waveforms, if they let you float the swanz.
    depending on the surgeon and the mda, stay out of the way and keep quiet. some like more interaction than others.
    oh make sure you dont contaminate anything sterile as OR circs and scrubs in the heart room tend to be a little condescending.
    d
  4. by   charles-thor
    During your cardiac rotation, try to read not only the relevant chapters in Jaffee, but more importantly attempt to get though as much of Hensley and Martin's "A Practical Approach to Cardiac Anesthesia" as possible - with a particular emphasis on the first 12 chapters. Enjoy!
  5. by   Quincke
    First, don't be overwelmed. There is a lot to do during heart surgery, but you will learn it. Not in the first couple of days, but over your heart rotation you will get a routine and feel much more comfortable than when you begin

    If the CRNA you are working with will let you, watch as much of the surgery as possible. It really took a lot of pressure off me the first time to not worry about charting and really focus on the surgery and the anesthesia and how they match up. I was really lucky, and this is what I did the first open heart I had: helped set the room up - this takes some getting used to b/c there are lots of drips, etc. that need to be ready, put the a-line in, watched the mda put the swan in, intubated, hooked up monitors, then monitored the patient until chest incision. Then, the CRNA let me watch what the surgeon did and helped me learn the timing of things like lungs down, heparin, titrating drips to get pressure where you want it for cannulation, and all the other things you will learn (be prepared to have BP problems when coming off CPB and after protamine). This was a great way to learn, and I hope that you will have the same opportunity. I also hope that any CRNAs who precept students in the heart room reading this will take it into consideration for us SRNAs doing our first heart.
    GOOD LUCK!!!
  6. by   louloubell1
    Quote from gaspassah
    listen carefully while on bypass, the surgeon will whisper table up or turn to me, then a little louder, then he'll yell, I SAID TURN THE TABLE!!! d
    That's funny gaspassah! I'm only in my first semester involving clinical rotations, and I've noticed that from certain surgeons in any case. I never seem to catch their first request for table change... seems like some of them enjoy saying it as quietly as possible the first time just hoping that you won't hear them so they can be very loud about it the next time. Too funny!

    Lou
  7. by   rn29306
    Quote from charles-thor
    During your cardiac rotation, try to read not only the relevant chapters in Jaffee, but more importantly attempt to get though as much of Hensley and Martin's "A Practical Approach to Cardiac Anesthesia" as possible - with a particular emphasis on the first 12 chapters. Enjoy!
    That book is awesome.
  8. by   UCDSICURN
    Good luck and be sure to let us know how it goes.
  9. by   MaleAPRN
    It wasn't that bad at all. It surely helped that I was with a brilliant veteran CRNA for that case. She walked me through each step of getting ready and especially during the most critical times during the procedure wherein we had to control the patient's BP. It's a matter of being well-prepared for anything that could go wrong. It was an eye opener for me and it surely has made me more vigilant than ever before. It's like an SRNA's rights of passage...to have your first bypass case. It's a way of them telling you, that you'll be a senior SRNA in a few months. Yipeeeeee!

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