Cardiac Emergency: Surgeon and PA Roles in Aortic Dissection

In the world of cardiac care, the balance between timely intervention and expert care is crucial. When a patient undergoing a heart catheterization procedure encounters complications that necessitate an emergency open heart surgery, understanding the roles of the surgeon, physician assistant (PA), and the surgical team is paramount.

Preparation and Response in Emergency Situations

The scenario you describe—where a patient requires emergency open heart surgery after a heart catheterization due to an aortic dissection—presents a critical situation. Typically, in well-equipped hospitals, there are stringent measures in place to ensure that the cardiac surgeon and their PA are readily available within a 20-minute drive, ensuring prompt response. This readiness is essential, as emergency sternotomies can take up to 30 minutes to prepare. The bypass team works swiftly to access the chest, minimizing the time between a patient's request and surgical intervention.

Diagnosis and Management of Aortic Dissection

If an aortic dissection is suspected, it can be confirmed using a transesophageal echocardiogram (TEE), which provides real-time images of the heart. If further confirmation is needed, a CT scan can be ordered. An aortic dissection, whether ascending or descending, requires a thorough evaluation to determine the appropriate course of action. Management options include close monitoring, surgical repair, or endovascular treatment.

The Role of the Surgical Team

The surgical team, including the surgeon, PA, and nursing staff, works in concert to prepare the patient for surgery. While the surgeon is scrubbing up, the rest of the team is in action. The patient's chest is often painted and drapes are placed, with the team ensuring the patient is properly positioned and prepared for surgery. This collaborative effort ensures that the patient is in the best possible state before the surgeon makes the first incision.

Real-Life Scenarios and Best Practices

In practice, scenarios where a patient is unexpectedly transferred from the catheterization lab to the operating room are rare but do occur. When they do, the surgeon often begins scrubbing while the patient is being prepped. In unstable patients, the response can be rapid, with the use of antiseptics like Betadine to quickly clean the chest. There may not be time to waste as the patient's condition may require immediate intervention.

Final Thoughts

The coordination and efficiency of the surgical team in these critical situations are essential. Hospitals and medical centers have protocols in place to ensure that the patient receives the best possible care in the shortest amount of time. While the described scenario is not common, the preparedness of medical staff makes it less of a nightmare and more of a routine challenge.