[HSF] Ahh, the Holiday Transfer. Would anyone do anything different?

[Mark Levinson]

On Nov 25, 2007, at 5:47 PM, Michael Firstenberg wrote:

>
> Please comment as I know many of you have been there (either on- 
> line or in private)..........

I would have handled this case the same...and the outcome would be  
the same.....you did everything right and
to the best of your ability.     The cards were dealt before he  
arrived.     Acute aortic dissections have
a high mortality rate...

Non-operative therapy has been recommended in some cases of acute  
type 1 as discussed by Tom Martin, but most
of us are not in the position to defend this decision and quote the  
odds to the family....whereas we know the outcomes
with surgery.      I reserve non-operative therapy for patients who  
have organ death on arrival (dead bowel, brain, liver)....and
these patients die soon thereafter.     If you decide against  
surgery, you will have to defend this decision with some
evidence that it is better than trying to fix it.         
Controversial....

I think you handled this case as best it can be....

Mark

Mark Levinson, MD.
Founder, Editor-in-Chief
The Heart Surgery Forum®
Multimedia Cardiothoracic Journal
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