Sixth Rotation: Clinical Cardiology Madigan Army Medical Center

***HONORS***So this was one of two electives during my 3rd year. The second will be in anesthesiology, which is two weeks long and begins immediately after my next rotation (final required 3rd year rotation in Family Medicine). The rotation was at Madigan Army Medical Center. I worked with a great doc, Dr. Kurt Kinney, who is an interventional cardiologist. I learned a lot during the clinic hours, but I also got to spend a fair amount of time in the Cath lab.

I actually even got to do most of a catheterization, which was very interesting. I was allowed to get femoral venous and arterial access, and I even floated a swan catheter. Dr. Kinney was very good about letting me do a lot.
The most interesting thing I saw on this rotation happened when we assisted another interventional cardiologist during an emergency. The patient, an 80 year old woman, came in with pulseless electrical activity (PEA). CPR had been initiated in the field by her husband, and advanced cardiac life support (ACLS) protocols were initiated when EMS arrived. One of the protocols is to give epinephrine. But no drug is truly benign. When I speed walked into the cath lab, the patient was on a ventilator and they were doing chest compressions while the catheterization was taking place (you don't see THAT every day!). When access was gained and the doc shot the contrast, the coronary arteries were totally clamped down. This was due to the epinephrine. When nitro was introduced into the arteries, they all opened back up. It was very interesting to see how medicines that we use to save a life and are standard protocol can also have a deadly effect. It is an image that will stick with me forever. I will never run a code and think about things the same way again...