Cardiac Care Unit
So this past month I have been resident in the CCU (Cardiac Care Unit). Since it is in fact what I want to do (cardiology), I have actually been enjoying it. We have had some real interesting, and real sick patients, and I think I have been holding down the fort well in the often busy overnight calls. We have had def had some stories though....
There was this one 27 year old guy with depression and paranoid schizhophrenia who took 100 pills of Cardizem, which is this blood pressure medication that can cause a dangerously slow heart rate and drop in pressure when you take too many. He was admitted to the CCU for monitoring overnight (but he was really fine). The next day, we hear a commotion and a nurse scream from the main area, and we see the patient, this 250lb, 5'10" guy, on the floor with a male nurse's aid in a headlock, wrestling him down. We ran to assist, as the nurses stood helpless in fear (rightfully so, he was a beast). Luckily the patient's mother was there to assist, so we all got him off and got him into his room. Somehow, while waiting for security, I brought him into his door, and stood by the door in between him and the unit. Why? I'm not sure, but I was scared. Like I always say, nobody likes a hero. And of course he is pacing around, with this fiery look in his eye, pants falling off, shirtless, and he comes into my face and lets out this scream. I thought I was going to crap my pants. But luckily I stood my ground. Finally security game and subdued him, and we shot him up with a B52 cocktail (a sedative combo of haldol and ativan and benadryl).
We have this one guy who came in with decompensated heart failure. He is in his 60s and has a an alcoholic cardiomyopathy--a huge, weak heart from years of drinking. So what happens in heart failure is you retain water into your lungs, legs, and even your body, causing swelling, shortness of breath, weight gain, etc... So this guy hasn't taken his meds for so long, and ate chinese food everyday, that he has probably 20 or 30 liters of excess fluid in him. I mean he is like 30 kilos over regular weight. He is swollen everywhere, you put a finger in his leg, and it makes a 2 inch deep indent. His whole belly is swollen, and the kicker, is his scrotum. It was probably the size of a a large melon, or even a pineapple. It was quite impressive, and it would make you cringe! He would have his roomate visit him, who would sit there and drink rum and coke out of a paperbag, trying to disguise it. Turns out this roomate of his also is a drunk, and has an alcoholic cardiomyopathy. Three days later, no joke, he was admitted to the CCU room next to his with heart failure as well! It was quite hysterical. They even are messing around with the same girl! So this guy has been entered into a study protocol for the Orqis pump, where they stick this huge 13 french catheter into his femoral artery, that goes to a pump, which goes back into the other femoral artery, which has a catheter going up to the aorta. The idea is to provide extra pumping power (an extra 1.5L/min of cardiac output), to help better perfuse his kidneys with blood, so that he can piss out all his extra fluid. Like a functional mini heart.... We'll see if it actually works..
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