[HSF] Bentall +CABG

[erdinç naseri]

Dear all,
!. Heparin was stoped 3 days ago
2.Forgot to tell that monocyte % is 40.( toxic allergic hepatitis or hepatotropic viral infection :EBV,CMV)
ınfection
> To: OpenHeart-L at lists.hsforum.com> Subject: Re: [HSF] Bentall +CABG> From: zzhoumd at pol.net> Date: Sat, 12 Jan 2008 13:18:15 +0000> CC: > > > HIT is one of the things I am thinking too. If not sepsis, when you see someone has purple fingers or toes, HIT is one of the causes.> > Z Zhou> > Sent via BlackBerry by AT&T> > -----Original Message-----> From: "Prasanna Simha M" <prasannasimha at gmail.com>> > Date: Fri, 11 Jan 2008 14:19:31 > To:OpenHeart-L at lists.hsforum.com> Subject: Re: [HSF] Bentall +CABG> > > My thoughts> Ventilation - get to an ARDSet type of ventilation - 6-7 mll/Kg Tidal volume> , FIO2 down to 40% or lesser and I/E 1:1 or comfortable levels. Phenytoin> loading dose and maintainance (may be able then to get off the> anticonvulsantinfusions). Remove Heparinas there is a possibility of HIT> (Heparin free flushes in all lines ) unless you can really do a HIT workup> and recheck still for sepsis as pletelet decrease may still be an occult> sign.> Step up the thyroxine dosage as even "normal" ;patients became sick> euthyroid let alone hypothyroid ones.> Is he bloated ? Is his conjunctivae edematous - if so consider CRRT/CAVHD> with local or no anticoagulation. You are giving a lot of diazepam etcin a> patient with altered renal and hepatic function and tht may also knock him> off. Is serum Ammonia available. consider hepatic protection with Lactulose> and gut sterilization.> Prasanna> > > On Jan 11, 2008 2:07 PM, erdinç naseri <enaseri at hotmail.com.tr> wrote:> > >> > Further information about the patient> > Unresponsive,No fever> > Intubated (IPPV,FIO2 %50,!'/min,PEEP6 mmHg):PH7.31,PO2 81,PCO2 38,Lactic> > acid 5.1,SO2 %97> > Repeat cranial CT:Completely normal: no infarct, no edema ( as far as CT> > can tell),Has bouts of focal and time to time generalized convulsions ( on> > Diazepam,clonazepam,Depakene)> > Abdominal CT: no fluid in peritoneal cavity,no sign of MVA.Abdominaldistention with negative tap and clear N/G fluid> > Repeat Thoracic CT: marked decrease in mediastinal air density,no> > perigraft collection,Bilateral pleural effusion(R>L): R tube thoracostomy.> > AST:900 ALT:667: Bilirubin(total/direct):6.01 /3.48,PT :17 sec,aPTT:96> > wbc:2200!,Platelet:40000,HB:13.1,Di-dimer:>10000> > BUN:170,Creatinin:3.4,Na :132,K:4.6> > FreeT4 :0.54,freeT3 :0.41,TSH:25.6( previously had thyroidectomy and was> > euthyroid preop),Giving tefor from N/G satrting 2 days ago.> > Total protein 4.5 Alb:2.6 : 200 cc 20 % alb everyday+ plasma.> > Prassana,claudia,michael and others, any thougt> > erdinc> > > Date: Thu, 10 Jan 2008 15:47:31 +0530> From: prasannasimha at gmail.com>> > To: OpenHeart-L at hsforum.com; ccm-l at ccm-l.org> CC: > Subject: [HSF] Image> > of the week> > 25 year old male with infundibular pulmonary stenosis (PS)> > and a> ventricular septal defect(VSD). Both the VSD and the PS are seen>> > particularly well in this case. Note the endocardial fibrosis around the>> > infundibular os and the ease at which it could have been mistaken for a> > VSD.> The last frame shows the VSD patch and after infundibular resection> > with> excision of a hypertrophied septal band.The RVOT gradient dropped to> > 9 mm Hg> on echo with laminar flow and the peak RV pressure was 32 mm Hg> > after> resection on direct recording versus a systemic of 102 mm Hg. It is> > not> often that we can get a photographable intracardiac anatomy in this> > subset> !!> > -- > Prasanna Simha M> >_______________________________________________> > 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> > -----------------------------------------> >> > > > -- > Prasanna Simha M> _______________________________________________> 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> -----------------------------------------