[HSF] My Picture of the week

[Nasser F. Abou'Seada]

IMHO ..... Definitely you've carried out the optimal choice ... I'd have
done the same should I have been in your shoes ..... and having OR ready
.... 
I've lost a case like that .... unfortunately short of time to transfer from
ICU to OR .... 

NFA
> -----Original Message-----
> From: openheart-l-bounces at lists.hsforum.com [mailto:openheart-l-
> bounces at lists.hsforum.com] On Behalf Of nand kejriwal
> Sent: Monday, November 06, 2006 1:38 AM
> To: OpenHeart-L at lists.hsforum.com
> Subject: Re: [HSF] My Picture of the week
> 
> Ben
> 
> Undoubtedly it is important to have a DEFINITIVE diagnosis of PE. However,
> there are situations where one may not have time to send the patient for
> CTPA. The last pulmonary embolectomy I did was a young man in his forties
> who had undergone some orthopaedic procedure. About 10 days post op, he
> suddenly became hypotensive. While arrangements were being made to
transfer
> him to ICU, he had cardiac arrest. Resuscitative procedures were
commenced,
> and we were contacted with presumptive diagnosis of massive PE. He was
> brought to OR still being massaged and markedly acidotic. I put him on
> bypass and fished out large clots from PA. He was sent to ICU with large
> doses of inotropes and ECMO, but died next day with multiorgan failure.
> 
> I shall be interested to know the opinion of the members whether operating
> upon him was the right decision. Since he was young, I decided to give him
> the best possible chance.
> 
> nand
> 
> Nand Kejriwal
> Consultant Cardiothoracic Surgeon
> Waikato Hospital
> Hamilton, New Zealand
> 
> On 11/4/06, Ben Bidstrup <benjamin.bidstrup at bigpond.com> wrote:
> >
> > Most important is a DEFINITIVE diagnosis of PE with CTPA. I have been
> > caught with the wrong diagnosis made on clinical and echo grounds. No
> > clot in PA and poor outcome.
> > Shock, not being managed by inotropes, failing RV on echo, inability
> > to do one of the slightly less invasive methods for clot removal.
> >
> > >Timely post.  I was asked yesterday by one of our ICU nurses what
> > >the indications were for emergency embolectomy in presumed PE. I
> > >guess there was a "code" on the oncology floor, and the clinical
> > >impression was that of a massive PE. Never got the patient back, so
> > >the issue of operative embolectomy was moot.
> > >I put the question to the group; what are your indications for
> > >operative intervention in the setting of pulmonary embolus?
> > >Steven Schwartz
> > >
> > >
> > >On Nov 3, 2006, at 2:16 PM, Edward Bender wrote:
> > >
> > >>I fished this out of a patient's pulmonary artery.  In shock
> > >>pre-op, normal hemodynamics post-op.  Thought the members would be
> > >>interested in using the photo for talks, instruction, etc.
> > >>
> > >>Ed Bender, MD
> > >><PE.jpg>_______________________________________________
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> >
> > --
> > Ben Bidstrup FRACS FRCSEd FEBCTS
> > Consultant Cardiothoracic Surgeon
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