What Really Happened...
Hey all!
I subscribe to Knowledge News (this nifty daily email with articles on totaly random subjects). Today the topic was what goes on in a bypass operation - written by a doctor in layman terms. I found it VERY interesting - because I never really thought about the details of what really happens in the OR. I have posted it here (I really hope this doesn't count as copyright violations or anything.) I will warn you that it is kind of graphic - and upsetting if you think about DAD in this position. Sarah couldn't get through it. Katie and I both read it and cringed - but in some ways I like KNOWING what was going on.
If you haven't all already cleaned up your own health acts - this may help. None of us EVER want to go through this.
Amy
Heart Surgery 101: The Ins and Outs
The patient lies in the middle of the cardiac surgical suite, flat on his back under bright lights, painted with an ochre iodine solution from neck to knees, then draped in multiple layers of sterile plastic and cotton. A vertical screen separates his head and neck from the site of the surgical action.
Behind this screen, the anesthesiologist does his magic, infusing a cocktail of oblivion-inducing drugs into the patient's veins, inserting a tube down the patient's windpipe, and ventilating him with a mixture of gases that keep consciousness mercifully at bay.
On the patient's left side, the pump team sets up shop, with a technician seated behind a low, rectangular stainless steel machine the size of a large desk. He's all about plumbing, preparing the tubes that will carry blood from the patient's stilled heart to the machine, through a cylinder where the dark purple blood picks up oxygen and turns cherry red and then flows back to the patient's body. Raised over the end of the table is a mammoth tray of tools--surgical hardware.
Getting into the Chest
The surgeon and scrub nurse wait on the patient's right, the surgical assistant on the left. With one vertical slice down the middle of the chest and a buzz of the saw down the center of the breastbone, or sternum, the patient's chest wall is breached.
The surgeon wedges a nifty little tool into the sternal split, and proceeds to crank open the chest. (At the end of the surgery, he will use something that looks like a meat hook to wind up the wire sutures that pull the edges of the bone back together--and write a prescription for enough narcotics for several weeks.) As the bone comes apart, a shiny pink pillow puffs up from below. This is the lung, protected in a slippery, clear envelope called the pleura, which lines the inside of the chest wall and the outside of each lung, letting the lung slide friction-free as it expands and contracts.
With the bony gap widened to six or seven inches, the surgeon removes the spreader and gently pushes aside the right and left lungs, covering them in wet, protective cloths. He is now in the middle compartment of the chest, the mediastinum. There, in a protective, transparent envelope called the pericardium, is the heart--a purplish, muscular little fist of an organ in its healthy state, pumping away with a powerful twisting contraction. Of course, since we're doing heart surgery for a reason, it might be a pale, flabby bag, draped in yellow fat, contracting with a weak squeeze.
Getting the Job Done
Getting in is the standard part. What happens next depends on what the patient needs. Sometimes it's a new valve inside the heart, or maybe two. Sometimes it's bypassing diseased coronary arteries on the surface of the heart with an artery brought down from the chest wall and attached beyond the blockage, or with a piece of a vein from the leg attached at one end to the aorta and at the other end beyond the blockage. Either way, the stitch work is so tiny that the surgeon wears glasses with little microscopes on the lenses.
Sometimes a bypass can be done without stopping the heart, and the surgeon sews in rhythm with the beat. But most times, the surgeon has to replumb the body, sending unoxygenated blood from the right side of the heart out to the mechanical pump and depending on the pump technician to run the machine and send the blood back to the aorta. Then the surgeon stops the heart with a mixture of drugs, letting it lie peacefully in the chest while repairs get done.
Getting Out
Going on the pump and coming off the pump can be white-knuckle times. Sometimes there is trouble restarting the heart. Sometimes the patient has to go back on the pump. But if all goes well, backing out is largely the reverse of getting in, with many checks in place.
All the tools and all the gauze sponges used for mopping up must be back where they belong (it's surprisingly easy to lose things in a blood-soaked operating field). The inside of the chest has to be dry (no leaking of blood from anywhere). Even then, tubes are left in the chest to let oozing fluids drain to the outside. These come out several days later, with a hard yank and a stitch or two to close the hole. The surgeon's work, he hopes, is done. It's nature's time to go to work and smooth over the cuts and stitches.
Elizabeth Reid, MD
March 10, 2005
I subscribe to Knowledge News (this nifty daily email with articles on totaly random subjects). Today the topic was what goes on in a bypass operation - written by a doctor in layman terms. I found it VERY interesting - because I never really thought about the details of what really happens in the OR. I have posted it here (I really hope this doesn't count as copyright violations or anything.) I will warn you that it is kind of graphic - and upsetting if you think about DAD in this position. Sarah couldn't get through it. Katie and I both read it and cringed - but in some ways I like KNOWING what was going on.
If you haven't all already cleaned up your own health acts - this may help. None of us EVER want to go through this.
Amy
Heart Surgery 101: The Ins and Outs
The patient lies in the middle of the cardiac surgical suite, flat on his back under bright lights, painted with an ochre iodine solution from neck to knees, then draped in multiple layers of sterile plastic and cotton. A vertical screen separates his head and neck from the site of the surgical action.
Behind this screen, the anesthesiologist does his magic, infusing a cocktail of oblivion-inducing drugs into the patient's veins, inserting a tube down the patient's windpipe, and ventilating him with a mixture of gases that keep consciousness mercifully at bay.
On the patient's left side, the pump team sets up shop, with a technician seated behind a low, rectangular stainless steel machine the size of a large desk. He's all about plumbing, preparing the tubes that will carry blood from the patient's stilled heart to the machine, through a cylinder where the dark purple blood picks up oxygen and turns cherry red and then flows back to the patient's body. Raised over the end of the table is a mammoth tray of tools--surgical hardware.
Getting into the Chest
The surgeon and scrub nurse wait on the patient's right, the surgical assistant on the left. With one vertical slice down the middle of the chest and a buzz of the saw down the center of the breastbone, or sternum, the patient's chest wall is breached.
The surgeon wedges a nifty little tool into the sternal split, and proceeds to crank open the chest. (At the end of the surgery, he will use something that looks like a meat hook to wind up the wire sutures that pull the edges of the bone back together--and write a prescription for enough narcotics for several weeks.) As the bone comes apart, a shiny pink pillow puffs up from below. This is the lung, protected in a slippery, clear envelope called the pleura, which lines the inside of the chest wall and the outside of each lung, letting the lung slide friction-free as it expands and contracts.
With the bony gap widened to six or seven inches, the surgeon removes the spreader and gently pushes aside the right and left lungs, covering them in wet, protective cloths. He is now in the middle compartment of the chest, the mediastinum. There, in a protective, transparent envelope called the pericardium, is the heart--a purplish, muscular little fist of an organ in its healthy state, pumping away with a powerful twisting contraction. Of course, since we're doing heart surgery for a reason, it might be a pale, flabby bag, draped in yellow fat, contracting with a weak squeeze.
Getting the Job Done
Getting in is the standard part. What happens next depends on what the patient needs. Sometimes it's a new valve inside the heart, or maybe two. Sometimes it's bypassing diseased coronary arteries on the surface of the heart with an artery brought down from the chest wall and attached beyond the blockage, or with a piece of a vein from the leg attached at one end to the aorta and at the other end beyond the blockage. Either way, the stitch work is so tiny that the surgeon wears glasses with little microscopes on the lenses.
Sometimes a bypass can be done without stopping the heart, and the surgeon sews in rhythm with the beat. But most times, the surgeon has to replumb the body, sending unoxygenated blood from the right side of the heart out to the mechanical pump and depending on the pump technician to run the machine and send the blood back to the aorta. Then the surgeon stops the heart with a mixture of drugs, letting it lie peacefully in the chest while repairs get done.
Getting Out
Going on the pump and coming off the pump can be white-knuckle times. Sometimes there is trouble restarting the heart. Sometimes the patient has to go back on the pump. But if all goes well, backing out is largely the reverse of getting in, with many checks in place.
All the tools and all the gauze sponges used for mopping up must be back where they belong (it's surprisingly easy to lose things in a blood-soaked operating field). The inside of the chest has to be dry (no leaking of blood from anywhere). Even then, tubes are left in the chest to let oozing fluids drain to the outside. These come out several days later, with a hard yank and a stitch or two to close the hole. The surgeon's work, he hopes, is done. It's nature's time to go to work and smooth over the cuts and stitches.
Elizabeth Reid, MD
March 10, 2005
posted by Amy @ 4:30 PM
1 Comments:
At 1:43 PM,
Anonymous said…
Amy your What Really Happened... was a healthy read. We need more of this in the internet community and articles about health, health, health and health are other health issues that you might consider. Our health is related to health issues and topics. Keep up the great articles and subject matter.
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