"It's Christmas Once again in San Diego!"

"And there is not a chance that it will snow!"

That's a real song. I heard it today when I was driving home from my first 30 hour call in the CCU. I was sort of giggling in my sleep-deprived haze of a way. It's fine with me that it doesn't snow. Great, in fact.

Call was fine as far as calls go. We had a code, which I hate. She was in the CT scanner. Then the resident on with me had a patient come in who was found dead. On a park bench, covered in vodka, homeless. Whoever found her called the ambulance. I guess one of the criteria for pronoucing someone dead is that they have to be at body temperature. And once they started to warm her back up she had a heart rate. Being down in the mid-80s actually may have saved part of her brain function. Cryo in a way. Sort of. Her pH was something awful like 6.8 (normal is 7.4) so she was full of her own body's acid.

Things I am learning on CCU so far:

• have all the cardic meds and doses at your fingertips for rounds
• sometimes a CABG is better than cath if you have diffuse disease or are at high risk for restenosis
• groin checks post cath
• beware of retroperitoneal bleeds
• ekg changes (lots)
• pts post cath need to be on plavix for at least a year, if not forever
• they should also be on asa, b-blocker, ace-i
• pts in heart failure are usually on the above plus a diuretic, including spironolactone
• to diures move from oral lasix, to iv, then oral bumex to iv, then sometimes up to dialysis
• creatinine can actually go down despite the diuresis if you push through to the point when the kidneys have better perfusion
• patients need to take it easy for about a week after cardiac cath
• they can take a shower, but don't sumberge the cath site in a hot tub or bath for a week

And there's more, but I'm finally getting tired again after my five hour "nap" this afternoon.

Hope you had a good weekend!