Being part of the Education and Training Committee, I was forced to be at the hospital during my day off. I know that this is part of what I bargained for but it really pains me to get up from bed and be at the hospital for some unofficial function.
The update was about coronary angiogram which is the Holy Grail in determining the coronary artery disease or CAD. Members of the health care team consider this procedure as the “Gold Standard” in diagnosing Coronary Artery Disease or CAD.
Coronary angiogram is a minimal invasive procedure to access the coronary circulation and blood-filled chambers of the heart using a catheter and an x-ray image of the blood vessels after there are filled with a contrast material. It is one of the several procedures to visually interpret to recognize occlusion, stenosis, restenosis, thrombosis or aneurismal enlargement of the coronary artery lumens; heart chamber size; heart muscle contraction performance, and some aspects of heart valve function. Members of the health care team consider this procedure as the “Gold Standard” in diagnosing Coronary Artery Disease or CAD.
Since it is one of the most common procedures performed to diagnose heart problems in our institution, the Education and Training Committee of the Division of Medical Surgical Care supported the cascading of the said update. Hence, my required attendance. My ranting has turned into raving as I begin hear what the expert had to say.
Being faced with situations wherein patients have to undergo coronary angiogram, it is crucial for the bedside nurses to be abreast with the information pertaining to the said procedure. Having more than the basic knowledge of coronary angiogram would enable the nurses to competently handle the concerns of the patients and their significant others before, during and after the procedure.
The clinical pathway was created in such a way that nurses will be able to render utmost patient care upon admission all throughout patient’s discharge. The lecture encompassed the preparation of the patient upto the postprocedure where in the patient has been sent to regular room. This include the readiness of the patient and/or significant others financially, physically and emotionally.
Participants in the lecture were walked through the equipment and materials used during the coronary angiogram procedures some of which were brought in by the speaker for better appreciation. Another good thing to note during the presentation was the discussion of the results of the said procedure performed. How to differentiate normal, insignificant and significant lesions from one another. Also highlighted are the postprocedural complications that will enable the nurse to competently intervene and refer if the need arises.
The lecture was really enlightening as it gave me the answer to every pulsating question I had about coronary angiogram.

I was at my former office this afternoon to meet up with my former officemate when I noticed that people are starting to flock at the parking lot infront of the abandoned building. I found out that my former teammate’s back dashboard was completely broken by a makeshift chair which according to some bystanders just flew out of the window of the abandoned building. It was a windy day today due to the typhoon at the northern part of the Philippines.
The parking lot infront of the abandoned building has a park-at-your-own-risk policy and my former teammate did not appear to be worried about the situation although the damage is totally alarming. Luckily, she has gotten her car a 5th wheel warranty that will cover for all the damages this unfortunate accident has caused the poor automobile.

The dorm has been undergoing section-by-section renovation. The ceiling on the hallway and the light fixtures are now presentable and they engineering team has started on renovating the other side’s bathroom. My confusion about the renovation of each room has been addressed when I asked one of the engineers how to go about it. He just said that we should request for that at the administrator’s office and they will allocate a day to finish all the repairs including the replacement of the blinds. I am really excited about it and I am willing to volunteer to stay in the room just to the repairs done.

The rainy season is now intensifying. There is no day that it did not rain. I am loving this season as it gives me a very good time to relax and curl up in my bed during my day off. I am now unearthing my sweaters as the weather makes the atmosphere colder in the dorm. Comforters are not enough to keep me warm and I am really shaken to the core whenever I am in the dorm.

I was again the charge nurse. One of my patients had an order for Troponin I and so I made a request, a charge slip actually and the whiny nursing aide asked me to make another charge slip as what I did was for the ER department. So succumbed to her howling. I was pretty sure that I charged Troponin I but I was surprised to learn the following day that what I requested was for Troponin T.
Troponins are protein components of striated muscle. There are three different troponins: troponin C, troponin T and troponin I. Troponins T and I are only found in cardiac muscle. troponin T (cTnT) and troponin I (cTnI) are released only following cardiac damage.
• Trop T – 84% sensitivity for myocardial infarction 8 hours after onset of symptoms (1); 81% specificity (1)
• low specificity – 22% for unstable angina
• advantages
o highly sensitive for detecting myocardial ischaemia
o levels may help to stratify risk afterward
• Troponin I or Trop I on the other hand has 90% sensitivity for myocardial infarction 8 hours after onset of symptoms (1); 95% specificity (1)
• low specificity for unstable angina – 36% – note however that there is evidence that (2)
troponin I elevation is useful for predicting in-hospital risk for unstable angina patients admitted to a community hospital. The association of ECG changes and high troponin I identifies a population at very high risk; however, the absence of both variables in patients with a diagnosis of unstable angina does not preclude the development of events
Source: www.gpnotebook.co.uk
In a nutshell, Trop T is very useful in determining myocardial ischemia while Trop I is widely used in determining unstable angina after the onset of chest pain.
It is a good thing that the patient had negative result for Trop T and the requesting doctor, who’s a pulmonologist did not make a fuss about the mistake.

This is a case of 31-year-old sfemale, single who was admitted for management of stage IV breast cancer. The terminal stage. She has had left mastectomy (removal of the breast) in 2009. Her family refused to go for chemo therapy and decided to treat the presenting symptoms.
The patient came in with fever and unproductive cough. She has been bedridden since February this year due to pain she experiences when walking. She also complains of constipation, abdominal pain, neck pain and has had episodes of vomiting.
Her lack of appetite has prompted the doctor to place nasogastric tube to serve as an access for her osterized feeding to meet her daily caloric needs.
The cancer cells have metastatized to her bones that cause her excruciating pain especially in the leg. She has been referred to pain management specialist and the doctor gave her Oxynorm round the clock. Her pain was too severe that she needs to be given with Nubain via IV as rescue doses.
There are times that she’s okay and conversant but most of the times, she was disoriented mumbling incomprehensible words.
She’s all being managed for infection in the blood (sepsis). Her white blood count still shoots up despite the protective environment that she has been placed in. Her red blood cells, haemoglobin and hematocrit are all going down. No blood transfusion was made although warranted because their religion, Jehova’s Witness, forbids this.
The family members were primed about the impending loss in their family. Her vitals are all going down at 4:00 pm, she was pronounced dead.
In terminal cases, the medical staff can only offer palliative management and emotional support. Her battle with cancer was over and it is sad that she has lost to it.