00:01:04,744
Before we did the ultrasound,
32
00:01:04,744 --> 00:01:07,455
and she said, "Let's put
a Swan-Ganz catheter in,"
33
00:01:07,455 --> 00:01:09,814
which was what we were doing
before and still are doing
34
00:01:09,814 --> 00:01:11,381
for some indications,
35
00:01:11,381 --> 00:01:12,821
so when you wanna know what's the pressure
36
00:01:12,821 --> 00:01:14,762
in the left side, right side of the heart
37
00:01:14,762 --> 00:01:16,633
putting on the artery, you can do that.
38
00:01:16,633 --> 00:01:18,443
Put that catheter that
has been there since
39
00:01:18,443 --> 00:01:19,764
the early seventies.
40
00:01:19,764 --> 00:01:21,395
But, you know, it's a central line.
41
00:01:21,395 --> 00:01:22,835
You have to have access to the patient,
42
00:01:22,835 --> 00:01:24,365
you have potential infection risk.
43
00:01:24,365 --> 00:01:27,019
In five minutes, we were
able to look at the lung,
44
00:01:27,019 --> 00:01:28,380
look at the heart,
45
00:01:28,380 --> 00:01:31,544
look at the cardiac output,
central venous pressure,
46
00:01:31,544 --> 00:01:33,266
and now act on it.
47
00:01:33,266 --> 00:01:35,723
So I told them, "Just a
little dose of diuretic.
48
00:01:35,723 --> 00:01:37,428
"If he drops his blood pressure,
49
00:01:37,428 --> 00:01:40,061
"we're gonna bring it
up with a basal pressure
50
00:01:40,061 --> 00:01:42,811
"to increase the vascular
resistance of the vessels,
51
00:01:42,811 --> 00:01:45,362
"not by giving more fluid,
because he has enough.
52
00:01:45,362 --> 00:01:48,794
"And we're gonna get fluid
out by a mechanical way,"
53
00:01:48,794 --> 00:01:51,253
meaning that we're gonna put
a catheter in, getting it out,
54
00:01:51,253 --> 00:01:54,170
trying to both help his pressure problem,
55
00:01:54,170 --> 00:01:57,230
blood pressure problem, and
his oxygenation problem.
56
00:01:57,230 --> 00:01:59,108
So that's, you know,
just in a few minutes,
57
00:01:59,108 --> 00:02:00,547
changing what we can do.
58
00:02:00,547 --> 00:02:02,042
And clearly, we don't have to move him
59
00:02:02,042 --> 00:02:04,966
to do a CT scan, we don't have
to put any needles in him,
60
00:02:04,966 --> 00:02:07,677
apart from the one we're gonna take to put
61
00:02:07,677 --> 00:02:09,847
the catheter right here,
62
00:02:09,847 --> 00:02:12,088
and we'll see how it goes,
63
00:02:12,088 --> 00:02:13,677
but we know exactly where we're heading,
64
00:02:13,677 --> 00:02:15,071
all at the bedside.
65
00:02:15,071 --> 00:02:18,488
(violin and piano music)
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