Thursday, Sept. 1, 2011
At the beginning of the last month of her fellowship, a young physician saw the emergency resuscitation and operating rooms — from the patient point of view.
Early one morning, Kelly Sawyer, M.D., was walking from the parking deck to meet with Michael Kurz, M.D., assistant professor in Virginia Commonwealth University’s Department of Emergency Medicine and Sawyer’s fellowship director, and Joseph Ornato, M.D., professor and chair of Emergency Medicine. Near the top of the North Hospital ramp, she began to experience chest pain, pressure and shortness of breath.
“I knew I was about to pass out and I tried to sit on the window sill at the top of the ramp,” said Sawyer. “Apparently I missed and my bag broke my fall.”
Members of the VCU Code Team, Emergency Department and Richmond Ambulance Authority responded within several minutes, with bystanders coordinating the first critical minutes after her collapse. Dr. Pawan Suri was called from the ED and rode in the ambulance with Sawyer. Suri and the ED staff initiated resuscitation efforts in the trauma bay, calling for cardiology and cardiac surgery consultants, while Kurz and Ornato also were contacted.
“They called me in my office and said, ‘Kelly’s sick, she’s in the ER asking for you,’” Kurz said. “I rushed down to the trauma bay and found Kelly looking awful…pale; she wasn’t breathing well enough for us to sustain her without intervention. I went to Kelly’s bedside, talked to her and explained just what we were going to do—which was to intubate her.”
According to Kurz, she was experiencing a life-threatening pulmonary embolism.
“They were trying to get IVs and an arterial line to monitor my blood pressure because it was very low but that was extremely difficult,” said Sawyer. “Cardiology responded rapidly and an ultrasound of my heart revealed part of the clot. Clinically I was deteriorating and I was given blood thinners, thrombolytics and high doses of epinephrine.”
Sawyer experienced a severe embolism, known as a saddle embolism that had blocked flow to the lungs and left side of her heart.
Sawyer said there can be small clots that go into the lung and move along causing minor chest discomfort. However, a massive pulmonary embolism causes complete blockage to blood flow, shutting off oxygen to the rest of the body—within minutes also depleting the heart muscles of oxygen, which can cause a massive heart attack and eventually cardiac arrest.
Most patients with a massive pulmonary embolism die, but sometimes in cases caught early, patients will recover after thrombolysis or embolectomy—surgical removal of the mass. For Sawyer, the clot removed was approximately two inches in length and the time from collapse to the operating room was about 45 minutes.
Unique to VCU is the Advanced Resuscitation Cooling Therapeutics and Intensive Care Center (ARCTIC) program for treatment of cardiac arrest patients. Therapeutic hypothermia is the standard of care at VCU and happened to be the focus for Sawyer’s fellowship and master’s degree thesis.
“I have taken call as one of the ARCTIC attendings for the last year and helped review all of our data for quality measures,” Sawyer said. “I analyzed our data and wrote a paper intended for publication. Now I have experienced our own therapy.”
Now on Coumadin, a blood thinner used to keep clots from forming, Sawyer is on the road to full recovery from her surgery a short 11 weeks ago.
Sawyer attributes her surgery’s success to the team of professionals at the VCU Medical Center, representing programs from cardiac surgery and emergency medicine to critical and post-resuscitation care. After spending time with them as a fellow in Emergency Cardiac Care, an attending in the Emergency Department and now a patient, she has developed a special relationship with the staff.
“I couldn’t have asked for anybody better than the physicians that were here that day,” said Sawyer. “This is one of the best examples of inter-departmental collaboration that I could have imagined.”
Born into a family in which she and her two sisters hold the same birth month and both her and her father are survivors of Hodgkin’s Lymphoma—Sawyer is no stranger to coincidences and overcoming health battles.
With her fellowship complete, Sawyer will continue to pursue a career in emergency medicine, focusing on emergency cardiac and post-resuscitation care.
For more information about the VCU Medical Center’s Department of Emergency Medicine, visit the www.vcu.edu/mcved.