Opposites Attract

Today, we did our last two surgeries: an ASD and another PDA.

A few drugs that have been very commonly used and I’ve heard a lot over the last two weeks are milrinone, sodium bicarbonate, and lasix.

Milrinone is a vasodilator (widens the blood vessels), and it works by increasing the force with which the heart pumps blood throughout the body. The widening of the blood vessels allows the blood to easily flow through your body. It helps improve cardiac output. *look below for definition of hypertension*

Bicarbonate is a base and CO2 is an acid (here’s where general chem finally comes into play), and they are both in your body. The bicarbonate buffers CO2 in your body and raises your pH because you want a normal one (ideally it is around 7.4).

Here is a picture of sodium bicarbonate!! I know everyone is dying to see it!

Lasix is a diruetic, which promotes the production of urine. Basically, it makes you “wee” out water. Heart failure makes you want to retain fluid and salt, so lasix is given to keep the kids “dry”. It is important to keep children (kids after cardiac surgery) dry because they have just been on bypass. If you allow the patients to drink a lot fluid, you run a risk of pulmonary edema (swelling in the lungs).

One of our patients yesterday that had AVSD surgery had a pulmonary hypertension crisis overnight. His pulmonary arteries were constricted so much that they were too small to let any blood flow to his lungs, aka blood wasn’t getting oxygenated. It is also hard to bag someone in a pulmonary hypertension crisis because their lungs are so stiff from lack of oxygen.

One of the ways that you can treat pulmonary hypertension is with sodium bicarbonate. During pulmonary hypertension or cardiac arrest you have a low pH because you have so much acid in your blood, and you want your blood to be basic. Yes, you will administer “sodium bicarb” (as the nurses call it) if you want to higher pH, but you want to figure out what caused the pH to drop. If you don’t figure out the cause, how are you going to solve the problem? In our case, it was because he had a pulmonary hypertension crisis.

**vocabulary lesson of opposite day**

There is hypertension and hypotension. Hypertension is when you have an abnormally high blood pressure, and hypotension is an abnormally low blood pressure.

There is hyperventilation and hypoventilation. Hyperventilation is when breathing exceeds our metabolic needs and causes alkalosis (blood pH too basic) and hypoventilation is when breathing doesn’t meet our metabolic needs, and causes acidosis (blood pH too acidic).

There is bradycardia and tachycardia. Tachycardia is why you have a rapid heartbeat and bradycardia is when when you have a slow heartbeat.

There is vasoconstriction and vasodilation. Vasoconstriction constricts the vessel (raises blood pressure), and vasodilation dilates the blood vessels (lowers the blood pressure).

(s/o to my Anatomy and Physiology teacher, Dr. Goessling, for giving me a basis of information to go off of throughout the whole trip)

This is one of our patients that had to go in for a second surgery. He’s happy and smiling and got to go home today!

Little Arvin was moved out of the ICU and into the step down unit!

Gonna miss this little one too!

I also went in the OR today and was able to sit in on the surgery for a few minutes. I took some videos, but don’t want to overwhelm anyone so I won’t post them…

Lots of Barney has been played/sung/danced too, so not too much of a change from home. (Shout out to Henry and Thomas if you are reading this, which I know you are).

Today is our last real day, but I might come in tomorrow because I just can’t say bye to our kiddos yet!! This has been an amazing experience that I’ll never forget!