This morning I completed the National Board of Echocardiography (NBE) – Advanced Perioperative Transesophageal Echocardiography examination (PTEeXAM). To achieve Advanced PTE board certification, one must pass the PTEeXAM, have an unrestricted physician license to practice medicine, and must either have come from a fellowship pathway (in my case, adult cardiothoracic…
It’s hard to comprehend the amount of money, time, examinations, and sacrifice that one has to endure over their youth to pursue physician training. On reflection, it seems like a blur, but I still remember so many pivotal milestones in my career – my first patient encounter, my first code…
Last weekend, I attended my adult cardiothoracic anesthesiology fellowship graduation at the John F. Kennedy Presidential Library and Museum followed by our Brigham departmental anesthesiology graduation ceremony on Wednesday. At the latter event, I was awarded the Fellow Of The Year award voted on by the current residents “in recognition…
Here’s a quick video summarizing the basics of my life as a cardiothoracic anesthesia fellow!
The induction of general anesthesia in patients undergoing cardiac surgery is often times different than non-cardiac surgery. At many institutions, these inductions tend to center heavily around high dose opioids due to the hemodynamic stability conferred by narcotics. When talking about fentanyl, this translates to anywhere from 50 – 100…
The hepatorenal recess (“Morison’s pouch”) is a potential space between the liver and the right kidney. With small volumes of intra-abdominal blood (hemoperitoneum), ascites, or even peritoneal dialysis, fluid accumulates in this recess, which shows up as a near-black stripe on ultrasound. This video shows Morison’s pouch containing no discernible…
After returning from the Society of Cardiovascular Anesthesiologists annual meeting in Chicago last week, I received my Butterfly iQ and have been using it over the last week!
Patients with chronic thromboembolic pulmonary hypertension (CTEPH) present challenges from a surgical and anesthetic standpoint. They often have significant pulmonary collateral vessels to bypass obstructed pulmonary vessels. This, in turn, can increase bronchial vessel flow which can congest the pulmonary vessels even during bicaval venous cannulation. Additionally, large thromboembolic loads…
For patients with difficult arterial access (namely calcified/narrowed femoral and subclavian arteries), a transcaval approach offers another alternative. In this technique, interventional cardiologists guide a catheter through the femoral vein into the abdominal inferior vena cava (IVC). Using prior CT imaging and intraprocedural fluoroscopy, they electrify a venous guidewire from…
The concept of a denervated heart is a significant consideration in patients receiving orthotopic heart transplants. When these donor hearts are procured, there’s no way to preserve native autonomic regulation (ie, vagal input). After transplantation, it can take many months/years before some semblance of autonomic regulation is reestablished. We can…