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Hey anyone have any resources for opening chests after cardiac surgery code blue?
Some vids for absolutely dummy beginners be great
Some vids for absolutely dummy beginners be great
1-800-CTSRG-STATHey anyone have any resources for opening chests after cardiac surgery code blue?
Some vids for absolutely dummy beginners be great
Guys please. Thank you for your opinions.
Now does anyone have any resources answering the question at hand?
Thank you
The short answer is no, we don’t. The long answer is that while we appreciate your patient commitment, none of us are willing to consider doing this so finding a resource seems like it’s of minimal utility.Guys please. Thank you for your opinions.
Now does anyone have any resources answering the question at hand?
Thank you
I’m not even anywhere close to your field, but IMO if this is an expected part of your job (which I guess it shouldn’t be based on every other response) then you should be asking the surgeons to train you how to do it.Guys please. Thank you for your opinions.
Now does anyone have any resources answering the question at hand?
Thank you
What is crazy?This is crazy. No way.
Sorry, but really...not sorry...the issue is not 'how/should I open a fresh chest'...it just isn't...the one off, crazy grab the wire cutters (if anyone in the icu has any idea what those are, let alone where they are) OK fine...game winning hail Mary from the opposite free throw line...advice on how to get ready for that? I....What was it? 9:2 condescension to helpful ratio? That's pretty good for sdn professors. Thank you.
Listen I'm good with all the derision...
Listen guys, is anyone on here cardiac icu please chime in?Sorry, but really...not sorry...the issue is not 'how/should I open a fresh chest'...it just isn't...the one off, crazy grab the wire cutters (if anyone in the icu has any idea what those are, let alone where they are) OK fine...game winning hail Mary from the opposite free throw line...advice on how to get ready for that? I....
Listen guys, is anyone on here cardiac icu please chime in?
Pls read post cardiac surgery cardiac arrest algorithms and come back here... it's linked above
If you all want to unload your majestic skills and knowledge base upon me then great fine, I bow down you are all so much better than me..I get it. Thank you...
Those youtube Houston vids are very good. Thanks BTW... I'm out
This is probably the best advice. If you want to know how to open a chest, you got to learn how they close it (and I can already think of 3-4 methods off the the of my head), and then be able to reverse it.Does the patient want a dummy beginner opening his/her chest?
If you must practice at the top of your license and think you're doing more good than bad, the best way to learn to open the sternal closure is to watch plenty of sternal closures.
Then reverse the things they do in reverse order. *** The dunning-Krueger effect takes place here, you don't know enough to not know that there is many different ways to close the chest and each way of closure could result in different disasters if you don't open the chest the correct way.
If I could end world hunger and save the pt's life at the same time by opening a patients chest, I could probably open a sternal closure. However, I have never had a situation where I felt I need to open the chest and I do a fair number of cardiac surgeries. So I highly question the premise that an anesthesiologist who's never opened a sternal wound would be the best person to open the chest.
I don’t take issue with the fact that sometimes ICU needs to reopen the chest before CTS can get there.To the neysayers, someone getting into the chest within the first few minutes of a post-sternotomy arrest is a core part of the CALS algorithms. It has, though, been a little slow to catch on this side of the Atlantic. I remember being one of the first Americans to take the online CALS course as a fellow several years ago, and not a lot of places have really embraced the concepts.
This should be part of the onboarding process for new cardiac intensivists at your shop. Ask the surgeons there to give a presentation to your department (probably should do it at least yearly), with pictures and video of opening a chest in a controlled fashion. A place of your size likely has a couple of bringbacks a month, so they should have the opportunity to get the images/video. The decision to have the intensivists involved likely came from CTS, so they should have a hand in ensuring you are competent enough for this very rare occurrence.
This is the same guy who was asking how to float a swan in another thread.Listen guys, is anyone on here cardiac icu please chime in?
Pls read post cardiac surgery cardiac arrest algorithms and come back here... it's linked above
If you all want to unload your majestic skills and knowledge base upon me then great fine, I bow down you are all so much better than me..I get it. Thank you...
Those youtube Houston vids are very good. Thanks BTW... I'm out
Before I get more entrenched in my stance, I would like to understand your situation more:Chill out guys, about 50% of my work is as a cardiac intensivist in a very high volume, high acuity, high complexity centre without fellows or residents...
Cardiac arrest following cardiac surgery
Cardiac arrest following cardiac surgery is surprisingly uncommon, considering the fact that the heart was already quite diseased (hence it needed the surgery) and then it has been cut, grafted, manually handled and perfused with perverse fluids. Apparently in America the rate is about 0.7-0.8%...derangedphysiology.com
- After five minutes of unsuccessful resuscitation the chest should be re-opened. External CPR is pointless in all of the common causes of arrest in this scenario. Therefore, CPR is something you do while waiting to re-open the chest.
- Non-surgical staff are encouraged to re-open the chest in an emergency.
I'm glad none of you have to encounter this. It is very much my job.
About once per year unfortunately for the last few years
OP -
I hear ya.
The ICU I began practice in had an active cardiac surgical program without any CT surgical team member in house. We used the STS Document on post-CT surgery arrest (attached) as our "protocol" and had some simulation stuff as way to "learn it" live. Never had to do it but the document (and CT surgeon-guided "practice" via simulation) took me from no understanding to at least a conceptual context.
This site has some steps to the process, and a couple vids at the bottom.
Hope this helps.
I know some damn good cardiac surgery PAs that are infinitely more capable of re-opening a fresh chest (that they’ve closed themselves 100s, if not 1000s of times) than anyone on this forum whose chosen to comment. I’d trust them over me or any other non-surgeon to open a post-op chest any day of the week.The article advocates that PAs or senior ICU nurses may be the optimal people to be trained for resternotomy. I cannot even begin to imagine how poorly that would go. Give me an anesthesiologist intensivist with no surgical training over that any day of the week.
The article was promulgated by the STS, and I posted it as a reference. I think it is a useful resource. While there is almost certainly a hierarchy of whom I’d prefer to be reopening a chest in an emergency, I think the concept of suggesting non-physician involvement is much more a way to underscore that reopening the chest is an absolute emergency, and getting someone (trained to do so) into the chest matters as much as who enters the chest.The article advocates that PAs or senior ICU nurses may be the optimal people to be trained for resternotomy. I cannot even begin to imagine how poorly that would go. Give me an anesthesiologist intensivist with no surgical training over that any day of the week.
yeah I did. It's right there. I post plenty on cardiac, echo, the bit of icu i know... Does everyone that asks a question have to preface it with their CV? Chill outTo be fair, your OP gave no information on why you, the anesthesiologist, had to reopen a sternotomy. You mentioned nothing about being in an intensivist role.
I also feel like your unwillingness to explain your situation borders on egotistical and dismissive towards the people you're requesting help from.
Thought this was about Witcher 3.
This.To the neysayers, someone getting into the chest within the first few minutes of a post-sternotomy arrest is a core part of the CALS algorithms. It has, though, been a little slow to catch on this side of the Atlantic. I remember being one of the first Americans to take the online CALS course as a fellow several years ago, and not a lot of places have really embraced the concepts.
This should be part of the onboarding process for new cardiac intensivists at your shop. Ask the surgeons there to give a presentation to your department (probably should do it at least yearly), with pictures and video of opening a chest in a controlled fashion. A place of your size likely has a couple of bringbacks a month, so they should have the opportunity to get the images/video. The decision to have the intensivists involved likely came from CTS, so they should have a hand in ensuring you are competent enough for this very rare occurrence.
You're definitely barking up the wrong tree here. CALS and re-sternotomy by non-cardiac surgery personnel is very much the standard at many, many centers. Unfortunately, standardized training is NOT routinely offered for something that is not in the realm of ordinary. The first post was exceedingly obvious to anybody who knows what CALS is.Before I get more entrenched in my stance, I would like to understand your situation more:
-How many pump/cardiac cases do you provide anesthesia for per year?
-How many pump/cardiac cases are done at your center per year?
-What is your typical census in the cardiac ICU?
-Does your program report to the STS database? If so, how many stars?
-How many emergent re-entrant sternotomies are performed per year in the ICU?
-How many of those re-entrant sternotomies are done by CT surgeon vs intensivist?
To be fair, your OP gave no information on why you, the anesthesiologist, had to reopen a sternotomy. You mentioned nothing about being in an intensivist role.
I also feel like your unwillingness to explain your situation borders on egotistical and dismissive towards the people you're requesting help from.
But what do you think the risk:harm ratio is in low acuity center where nobody has ever done it? Like the janitor would have just as much knowledge as the personnel. CT surgeons love to blame everyone else for anything that happens to their patients because their metrics are so important to their compensation--having some poor sucker try to open the chest and cut/tear something vital mid code then get blamed for making the situation unsalvageable doesn't appeal to most people. I agree if they want to not be in house to deal with their own bull**** and want this to be done they need to create an in-service program and protocol for it.You're definitely barking up the wrong tree here. CALS and re-sternotomy by non-cardiac surgery personnel is very much the standard at many, many centers. Unfortunately, standardized training is NOT routinely offered for something that is not in the realm of ordinary. The first post was exceedingly obvious to anybody who knows what CALS is.
Odds are, any non-CT surgeon opening the chest is going to be doing it for the first time. But given the statistics surrounding post-cardiac surgery arrests, they're almost always salvageable problems by simply opening the chest.But what do you think the risk:harm ratio is in low acuity center where nobody has ever done it? Like the janitor would have just as much knowledge as the personnel. CT surgeons love to blame everyone else for anything that happens to their patients because their metrics are so important to their compensation--having some poor sucker try to open the chest and cut/tear something vital mid code then get blamed for making the situation unsalvageable doesn't appeal to most people. I agree if they want to not be in house to deal with their own bull**** and want this to be done they need to create an in-service program and protocol for it.
I definitely am not. You're assuming my stance and arguing against an imaginary take that was not endorsed by me.You're definitely barking up the wrong tree here. CALS and re-sternotomy by non-cardiac surgery personnel is very much the standard at many, many centers.
To the neysayers, someone getting into the chest within the first few minutes of a post-sternotomy arrest is a core part of the CALS algorithms. It has, though, been a little slow to catch on this side of the Atlantic. I remember being one of the first Americans to take the online CALS course as a fellow several years ago, and not a lot of places have really embraced the concepts.
This should be part of the onboarding process for new cardiac intensivists at your shop. Ask the surgeons there to give a presentation to your department (probably should do it at least yearly), with pictures and video of opening a chest in a controlled fashion. A place of your size likely has a couple of bringbacks a month, so they should have the opportunity to get the images/video. The decision to have the intensivists involved likely came from CTS, so they should have a hand in ensuring you are competent enough for this very rare occurrence.
To clarify, my stance is very similar to the quoted comments:This.
If CTS expects in-house help to open chests acutely in the unit, they should be providing the training.
Can you please just leave it so we can discuss this a bit? We're getting some good chat going now, don't derail itI definitely am not. You're assuming my stance and arguing against an imaginary take that was not endorsed by me.
Of the four institutions I've worked at in a CTICU setting, surgeons have been involved in the training of chest re-sternotomy zero times. The one location that did have any form of training was by the ICU team.I definitely am not. You're assuming my stance and arguing against an imaginary take that was not endorsed by me.
Also is it the standard that the non-cardiac surgery personnel go on SDN to get their training?
To clarify, my stance is very similar to the quoted comments:
If sternal re-opening is expected of the intensivists, the surgical team should be involved in the training. The sternal closure device/method are often institution specific and even surgeon specific.
Asking a group of people on the Internet who have not opened the chest regularly on where to find "dummy beginner" material is not a responsible way to obtain the training needed.
I have never said the intensivists with the right training should not open the chest in a cardiac emergency. Nor have I ever said that the chest shouldn't be opened during a post-sternotomy emergency.
I think that's one reason why it has been slow to catch on in the states. It's a bunch of people talking about what you SHOULD do in theory, without any practical knowledge or experience. I spent a bunch of time with surgeons and my CCM attendings going through ECMO cannulation, and felt like I could get through it on my own, if I really needed (less so now, as I haven't scrubbed in since fellowship). If we spent nearly the same amount of time going through how to re-enter the chest with the surgeons, I'd feel less than completely lost, should the situation arise. As is, I direct the resuscitation, while standing over my surgeons shoulder going, "Are you going to open the chest now? Come on, open the chest now. The OR is taking forever, let's open the chest now."Of the four institutions I've worked at in a CTICU setting, surgeons have been involved in the training of chest re-sternotomy zero times. The one location that did have any form of training was by the ICU team.
You're clearly not quite grasping that "dummy beginners" with no OR experience are in fact expected to open chests in many centers around the country and the world. And the STS recommended training is in fact a bunch of "dummy beginner" material (see https://www.csu-als.org/page/CERTIFICATIONRECERTIFICATION)
Thanks for the support, no big deal...So don’t pile on the OP for trying to do the same