[HSF] Intimal Tears

[Tea Acuff]

Of course the problem with logic and prospective complications is that one can argue either way retrospectively. Some are stronger arguments (as in Ani's calculations), but none are clear. 

tea


----- Original Message ----
From: Prasanna Simha M <prasannasimha at gmail.com>
To: OpenHeart-L at lists.hsforum.com
Sent: Monday, February 4, 2008 10:45:19 AM
Subject: Re: [HSF] Intimal Tears

Playing Ani's ethics game - is it ethical to postpone surgery to
demonstrate  liabilities (which may not ever occur or if occurs may not
change outcomes and  is in no way concerned with patient outcome ) versus
going ahead with surgery (whose outcomes also may not change.
Prasanna

On Feb 4, 2008 5:19 PM, Ani Anyanwu <anianyanwu at hotmail.com> wrote:

> > and close the rent with a purse string. The last option is remove the>
> dilator , compress and cancel the case for 24 hours.
>
> Prasanna
>
> This last option has two advantages - 1) It will differentiate a carotid
> puncture related stroke from a surgeon related stroke - you never know what
> the anesthesiologist has done and if any drugs have been given. We recently
> had a patient stroke after direct administration of norepinephrine and
> propofol into the carotid artery (this was in an ICU patient with the line
> placed by a surgeon). 2) Avoids a neck incision.
>
> We had a similar case to yours in a child when I was at Harefield, where
> we could not get the ACT to rise despite boluses and boluses of heparin. In
> the end doing it the old fashioned way worked (directly injecting into the
> RA). At some point in the surgery the right pleura was opened to reveal
> white fluid (propofol) - all the medication had been going straight into the
> pleural cavity where the tip of the line resided.
>
> Ani
>
>
>
>
>
> >



-- 
Prasanna Simha M
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