AW: [HSF] Intimal Tears

Sun Feb 3 22:49:55 EST 2008

Tea

Is this not easier said than done? Presenting the facts will often make it invariable in a logical discussion that one will have to give opinion as to how the facts arose.

Surgeon: We found some bleeding in the right side of the chest but fixed it (fact)
Relative: Thank goodness. Where was the bleeding from?
Surgeon: An artery above the top of the lung was bleeding into the chest (fact)

Now the problem starts...

Relative: But you did not operate on the lung?
Surgeon: No (still fact)
Relative: So why was it bleeding there?
Surgeon: Well there are some things we do during the surgery that can affect the lungs or the blood vessels around them
Relative: Like what
Surgeon: (opinion)

So the speculation has to start. The only way I can see the conversation going another direction is if in starting one did not stick to the facts or gave incomplete facts.

Surgeon: We have fixed the bleeding around the heart (incomplete fact)
Relative: Thank goodness. So no more bleeding?
Surgeon: No..all fixed (fact)
Relative: Why was it bleeding?
Surgeon: A tenth of patients having surgery bleed whatever we do and we have to go back and fix it (irrelevant fact), your husband also has a condition called coagulopathy so his blood does not clot well (unrelated fact)...whatever you do some patients will bleed (fact)
Relative: Yes strange you say that he bleeds sometimes when he brushes his teeth.
Surgeon: Really? Well he must be a bleeder then (bull@#$t)....
Relative: Thank you doctor, thank you for saving his life. God bless you.

> Date: Sun, 3 Feb 2008 14:04:42 -0800> From: tacuff at swbell.net> Subject: Re: AW: [HSF] Intimal Tears> To: OpenHeart-L at lists.hsforum.com> CC: > > Did you mean omit or admit? > I think all you have to do is describe, either that you found the bleeding and stopped it, or if you like where the bleeding was from. You don't have to give an opinion as to how it came about. Opinions are not as objective as findings. If you are pressed answer truthfully your opinion and just add that it is a described occurence after such procedure, which is again the truth without specualtion.> > tea> > > ----- Original Message ----> From: Dr. Roberto Battellini <battr at medizin.uni-leipzig.de>> To: OpenHeart-L at lists.hsforum.com> Sent: Sunday, February 3, 2008 10:23:25 AM> Subject: AW: [HSF] Intimal Tears> > Giuseppe,> I had the same experience twice. But if you open the pleura and look at the> haematoma, you will recognize the problem. Of course, the one who put the> catheter will not...It is a not uncommon complication of jugular indwelling> catheters.> I agree, it is better for the patient to admit errors.> Roberto> > -----Ursprüngliche Nachricht-----> Von: openheart-l-bounces at lists.hsforum.com> [mailto:openheart-l-bounces at lists.hsforum.com] Im Auftrag von Macbook> Gesendet: Sonntag, 3. Februar 2008 16:32> An: OpenHeart-L at lists.hsforum.com> Betreff: Re: [HSF] Intimal Tears> > Nasser,> > two weeks ago a did an AVR + PFO closure in a quite young woman > (about 50). My resident opened the patient and did a large opening of > the right pleura. At the end of the procedure I sucked almost 1 liter > of blood from the right pleural cavity (I said to myself that this > was blood collected during the operation). The day after the patient > was extubated and well but there was still some bleeding from the > right chest tube. The patient was reexplored by a collegue who found > nothing. The patient continued to bleed and on postop day 2 I > reexplored the woman. I found a bleeding spot from the apex of the > parietal pleura. It was clearly related to the IJV catheter but the > anesthesist said that it was related to surgery!!! BTW I put two > stitches and stopped the bleeding. However, as the blood was quite > red and I was worried about an arterial lesion I asked the vascular > surgeon to do an intraoperative arteriography that was negative. The > patient luckily did very well. We all make mistakes but it is nice to > admit them.> > Giuseppe> > > Il giorno 01/feb/08, alle ore 07:59, Nasser F. Abou'Seada ha scritto:> > > "Frankly, I'm surprised I've never encountered this complication > > until now"> >> > Hal> > That adds to your critical observance as a surgeon, recognizing the > > fault> > first time seeing it. I faced that situation before in a 55 y old > > female> > having a straight forwards Mitral repair. everything went smoothly > > yet there> > was some bleeding welling up in the pericardium, that we could not > > come off> > bypass ........ all manouvres to find out the source of bleeding were> > evading ..... blood seemed to come from around the SVC upper part, > > where> > nothing was ever touched .... patient passed off after some 5 hours on> > bypass and blood thinning out. On table autopsy, I dissected around > > the SVC> > up to the IJV.... to find the whole area bathing in blood, > > ecchymosed ....> > and blood perculating through the wall of the vein .. down the > > sheath ....> > around the SVC ..... into the pericardium .. !! .... opening the vein> > longitudinally, multiple non peneterating longitudinal tears were > > found in> > the intima of the RIJV ... !!!! ... inquiring in retrospect, the newly> > appointed anaesthesiologist tried many times before securing the > > IJV cannula> > in place .... as usual ... mortality was ascribed to the > > surgeon .... !!!!> > ... a new lesson with a hard price ..!! .. never forgotten ..> >> > NFA> >> >> >> >> >> >> > On Jan 31, 2008 7:09 PM, <Hgrmd at aol.com> wrote:> >> >> Don,> >> My assistant is pretty strong, but I'm not blaming him. > >> Frankly, I'm> >> surprised I've never encountered this complication until now.> >>> >> Hal> >>> > _______________________________________________> > OpenHeart-L mailing list> >> > Send postings to:> > OpenHeart-L at lists.hsforum.com> >> > To UNSUBSCRIBE, to CHANGE email address, or to view archives:> > http://mmp.cjp.com/mailman/listinfo/openheart-l> >> > All messages transmitted by the OpenHeart-L are subject to the > > policies and> > disclaimers posted at:> > http://www.hsforum.com/listdisclaim> > -----------------------------------------> > _______________________________________________> OpenHeart-L mailing list> > Send postings to:> OpenHeart-L at lists.hsforum.com> > To UNSUBSCRIBE, to CHANGE email address, or to view archives:> http://mmp.cjp.com/mailman/listinfo/openheart-l> > All messages transmitted by the OpenHeart-L are subject to the policies and > disclaimers posted at:> http://www.hsforum.com/listdisclaim> -----------------------------------------> > _______________________________________________> OpenHeart-L mailing list> > Send postings to:> OpenHeart-L at lists.hsforum.com> > To UNSUBSCRIBE, to CHANGE email address, or to view archives:> http://mmp.cjp.com/mailman/listinfo/openheart-l> > All messages transmitted by the OpenHeart-L are subject to the policies and> disclaimers posted at:> http://www.hsforum.com/listdisclaim> -----------------------------------------> _______________________________________________> OpenHeart-L mailing list> > Send postings to:> OpenHeart-L at lists.hsforum.com> > To UNSUBSCRIBE, to CHANGE email address, or to view archives:> http://mmp.cjp.com/mailman/listinfo/openheart-l> > All messages transmitted by the OpenHeart-L are subject to the policies and > disclaimers posted at:> http://www.hsforum.com/listdisclaim> -----------------------------------------
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