MEDICINE AND THE UNEXPECTED
(THE SHOCK FACTOR)
Dave Dageforde, MD
“L
et’s go…we’re losing his pulse.” “NoNo…v-fib.” “Initiate CPR…give me
an endotracheal tube…I can’t see
the cords; push down on the neck. There, I
got it.” “Let’s go…Let’s go…c’mon people; grab
the sheet…1-2-3 move… (he’s on the cart)…
GOOOOOO! My words resonated throughout
the catheterization laboratory while the patient
was flung onto the transport stretcher. I jumped
on top of the patient’s stretcher and continued CPR while my colleague
bagged the patient on the way to the operating room (OR). Four cath
lab staff shoved the stretcher down the hall towards the elevator as
fast as they could proceed.
The early days of percutaneous transluminal coronary angioplasty
(PTCA) were unlike anything I would have imagined during my
cardiology fellowship. The first angioplasty was performed in Switzerland in 1977 while I was still in fellowship training. Within two
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LOUISVILLE MEDICINE
years after I joined our cardiology practice, Dr. R.A. and I underwent
“formal” PTCA training, which was literally, “see one, get help with
one, do one.” Dr. R.A. and I observed one case in Indianapolis, the
cardiologist from Indianapolis came to Louisville and performed
one case with us, and then we were on our own.
I continued CPR while we crammed ourselves into the elevator.
As the elevator doors opened to the second floor, the staff pushed the
stretcher down the narrow hallway, opened the doors to the OR and
lifted the patient onto the OR table. “Clear out,” Dr. G, the cardiovascular surgeon, spoke authoritatively; and the cath lab team quickly
left the room. I stayed and continued performing CPR standing on a
stool beside the patient who was lying on the OR table. The surgeon
told me to continue CPR while he literally threw a small bucket of
iodine onto the chest and the surgical team scrubbed the patient’s chest.
“Dr. D, move your hands, just for a second,” the open-heart surgeon
barked as I continued CPR while he made the incision. The sternum
was sawn in two and the pericardium exposed. With one quick move,