Welcome to my new site!
Hey guys! welcome to my new website. My name is Pete, and I am here to talk to you about my adventures in medicine. I am a PA in the operating room and I have many experiences that I need to share before they are forgotten! Take a look around, feel free to contact me to talk about anything and everything medicine. Check out some cool surgical stuff below..
Hi guys Pete here. Today I will be talking about a case study for carotid disease. A 75-year-old gentleman presented to The emergency department with acute onset of left-sided numbness and weakness while gardening at home. He has a relevant past basketball history of hypertension high cholesterol and diabetes as well as smoking. No past surgical history. Family history is significant for heart disease. His occupational history is that he worked as an arborist company called Scranton Tree Service. Currently his vitals are stable in the emergency department. A carotid ultrasound was obtained and showed bilateral carotid stenosis.
So what did we do?
Pathophysiology of carotid disease.
Carotid disease makes up one third of every stroke in the United States. Is caused when a piece of plaque breaks off from the carotid artery he and travels to the brain embolizing one of the vessels and thus creating a stroke. National guidelines recommend that any carotid disease greater than 80% blocked carotid duplex should be treated with surgery, or anything over 50% stenosis with symptoms correlating to that carotid artery he should be treated with surgery. This gentleman had bilateral carotid stenosis of about 70 to 80%. He was seen by the neurologist who had declared him to have a cerebrovascular accident and positive CAT scan of the head. Because of this positive finding it is recommended to wait at least four weeks before embarking on carotid surgery. This gave us some time for our patient to see a cardiologist and have his heart checked out prior to receiving anesthesia.
Our patient underwent right carotid surgery with patch angioplasty.
This is a very elegant surgery and can be explained as follows.
Patient was brought into the room procedure was verified a timeout was performed patient was prepped and draped a 3 inch incision was made on the right side of the neck. Careful dissection was undertaken and the facial vein was visualized and divided. The carotid bulb resided underneath the facial vein. Just a proximal control of the external internal and common carotid artery's was obtained. 7000 units of heparin given systemically and all arteries were clamped. An arteriotmy was performed and plaque was exposed. Plaque was them shelled out of the arteries. Eversion endarterectomy was performed of the external carotid artery. A bovine pericardial patch was sewed onto the artery. Good back bleeding was noted from the internal carotid artery When unclamped. Incision was then closed using layers of Vicryl and Monocryl. Hey drain was placed in the neck. The procedure was tolerated well by the patient. He stayed in the hospital for one night and was discharged postoperative day one.
Well there you have it. That is a normal carotid surgery for a patient who was symptomatic and had a stroke relating to his right carotid artery he. Check back with me later for more stories
So what did we do?
Pathophysiology of carotid disease.
Carotid disease makes up one third of every stroke in the United States. Is caused when a piece of plaque breaks off from the carotid artery he and travels to the brain embolizing one of the vessels and thus creating a stroke. National guidelines recommend that any carotid disease greater than 80% blocked carotid duplex should be treated with surgery, or anything over 50% stenosis with symptoms correlating to that carotid artery he should be treated with surgery. This gentleman had bilateral carotid stenosis of about 70 to 80%. He was seen by the neurologist who had declared him to have a cerebrovascular accident and positive CAT scan of the head. Because of this positive finding it is recommended to wait at least four weeks before embarking on carotid surgery. This gave us some time for our patient to see a cardiologist and have his heart checked out prior to receiving anesthesia.
Our patient underwent right carotid surgery with patch angioplasty.
This is a very elegant surgery and can be explained as follows.
Patient was brought into the room procedure was verified a timeout was performed patient was prepped and draped a 3 inch incision was made on the right side of the neck. Careful dissection was undertaken and the facial vein was visualized and divided. The carotid bulb resided underneath the facial vein. Just a proximal control of the external internal and common carotid artery's was obtained. 7000 units of heparin given systemically and all arteries were clamped. An arteriotmy was performed and plaque was exposed. Plaque was them shelled out of the arteries. Eversion endarterectomy was performed of the external carotid artery. A bovine pericardial patch was sewed onto the artery. Good back bleeding was noted from the internal carotid artery When unclamped. Incision was then closed using layers of Vicryl and Monocryl. Hey drain was placed in the neck. The procedure was tolerated well by the patient. He stayed in the hospital for one night and was discharged postoperative day one.
Well there you have it. That is a normal carotid surgery for a patient who was symptomatic and had a stroke relating to his right carotid artery he. Check back with me later for more stories
The Disclaimer Message
Not all surgery is rainbows and butterflies, as you will see on this website. This site is slightly different than the normal medical mumbo-jumbo. This is about the delicate balance. I knew that when going into med school there would be difficulties ahead of me. I never would've imagined how hard it would be to juggle a full-time medical job and a full-time life outside of work. The reality is- it is hard. It takes a strong-willed individual to get up every single morning at 5 AM work for 12 hours or more come home and do it again. Five days a week every other weekend. I believe strongly that this is an additive process as I am feeling more and more burnt out; colleagues would also agree with that statement. The problem with working in surgery is that it is high stress almost 100% of the time. This no doubt, increases the amount of anxiety and fatigue your body will go through in a normal day. While weekends are usually meant for recovery, they mostly get spent catching up on projects and housework that fell to the wayside over the week. For instance, life happens. Perfect example, I spent this past Saturday dealing with my nieces conformation party and speaking with Tent Rental Scranton to try and figure out a plan for her party. Things just come up and you barely have a chance to breathe. Before you know it Monday is here again, and the cycle continues. I don't want this to sound like a warning more so just some advice. When you were looking for a job in the medical field make sure that they have very good time off and vacation packages. Spent some time picking days to take vacations stagger them throughout the year. This will be your time to relax and take a load off. Nothing slows down as my medical attending would say "the longer you stay the longer you stay" this statement reflects how busy life is in the medical field. Consults, new patients, and other problems will constantly arise in the hospital and you are never done with your day. Sometimes you just have to say enough is enough- it's time to go home. The moral of the story - make sure you do research before embarking into the medical field.