Category Archives: aortic dissection
Written by Ayetzi Nunez (class of 2014-2015)
THE HOUDINI RADIUS
Monday, March 16, 2015, 7am-12:45pm; 5 hours and 45 minutes.
This was my first sitting in Dr. Harken’s lecture and observing in the OR.
Dr. Harken’s lecture was about aortic aneurysm, how to detect them and how to care for patients with them. He also gave a brief description of the different types of aortic aneurysms. The types of aortic aneurysms that he discussed were Fusiform, Saccular, Michaic, and Dissections aneurysms.
Fusiform – The aneurysm bulges in all directions and has no distinct neck. The fusiform aneurysm does not present any symptoms but there is a possible rupture if it’s not treated. (Definition was found on Mayfield clinic website)
Saccular – (most common, also called “berry”) the aneurysm bulges from one side of the artery and has a distinct neck at its base. With this type of aneurysm the larger the pocket the higher the tension is in the pocket. (Definition was found on Mayfield clinic website)
Michaic aneurysm– it is rare and is caused by viruses such as syphilis and salmonella.
An aortic dissection– the inner layer of the aorta tears. Blood surges through the tear, causing the inner and middle layers of the aorta to separate (dissect). If the blood-filled channel ruptures through the outside aortic wall, aortic dissection is often fatal. The aortic dissection aneurysm does present pain (irritation) and there is lots of pain when they are cut. (Definition was found on Mayo clinic website)
Operating Room Experience
This surgery was about fixing a fracture on the forearm of a male patient that had fallen and landed on his right arm. The patient is a male with a history of stroke (right side affected), and a history of drinking alcohol.
When I arrived to the OR, the patient’s right arm was being prepared. One of the nurses scrubbed the arm twice and then wiped it dry. During that time, the surgeons, a PA, and the other nurse where putting their sterile gown and gloves on. I did not scrub in for this surgery because I was not asked to do so but I wore the lead vest due to the x-ray machine that was used during the surgery. Right from the moment I walked inside this OR I felt welcomed and as if I was a part of the team. Everyone was professional and helpful. Elka Jacobsen PA-S was very informative about PA school and about the surgery. As the surgery was moving along she instructed me where and how close I could stand to the team doing the surgery. She was a great guide for me. Dr. Shah, the main surgeon who was teaching the other surgical student, was also great. As Dr. Shah taught, his students and I listened carefully to everything he said. Dr. Shah’s way of teaching is smooth and he also made it look easy. He created a relaxed environment that was conducive to learning. The nurses and the surgical techs where very nice too and did a good job in guiding me.
After the arm is prepped, the surgeon drew a line down the arm where the incision is going to be made, then smaller lines were drawn across the main line. These smaller lines are done for the closing, to make sure the skin is matched perfectly. The incision is made and then he proceeds to find the artery and the nerves in the arm. Dr. Shah does not use the mechanical tourniquet because it is easier to find the artery without it also preventing cutting into it by accident. Dr. Shah stated that when a tourniquet is used it becomes more difficult to find the artery. They found the artery by looking and feeling for the pulsating movement. The original x-ray showed that there were 2 fractures present, one on the radius and one on the ulna. These fractures look like they were an oblique or spiral in the middle of the arm. Dr. Shah decided that they would fix the radius first and then fix the ulna.
Fixing the radius
After the section of the bone that was fractured was exposed the surgeon and the surgeon student cleaned it. They removed any bits of tissue that were attached to it, and they also smoothed the broken edges of the bone. Then the reduction was done, they inserted 2 screws, in an x shape, to hold the bones together. This is when they attached a small plate to secure the bone in place. After the plate was secured the surgeon bends the arm at the elbow and noticed that something was not right, so he tries the maneuver a few more times and then decides to check radius on the proximal end. He found another fracture that was not visible on the original x-ray. When I looked at the original x-ray it looked like nothing is wrong with the bone at that section. They took more x-rays right over there to make sure he did have another fracture, and it was confirmed. This was fixed the same way, with a difference that a larger plate was placed and the original small plate that was placed in the middle was also changed for something larger. Dr. Shah is thinking that this might have been a spiral fracture, so he decided to look at the distal end to make sure there were no fractures there and “viola” there was another fracture. This also got fixed the same way. At this moment they decided to put two plates at each site of the fractures on the radius, with a total of 6 plates.
Fixing the ulna
For this section of the arm was a little tricky. They did another incision by the ulna and the forearm was put in an upright position, Elka was holding the arm by the hand for this. After the bone was cleaned they were having difficulty making that perfect bone to bone match and it looked like it was due to a small piece of the bone that was partially hanging. To fix it they removed the small piece of bone, cleaned it and plugged it back in with the rest. They finally made the perfect match, beautifully done, added some screws and a plate. More x-rays were taken to make sure that there were no more fractures present and to show the work done.
The arm was rinsed very well with normal saline, inside and out. They used dissolvable suture and then they added staples to close the incisions. Some dressing, bandage, and a splint were put on the arm to keep it immobilized.
The procedure was amazing and left me wanting more.