[HSF] endocarditis

[gustavo abuin]

Thanks Michael, I`ll keep in consideration your words. All this song is 
because the guy is 28 years old. In a 82 year old lady I think it would be 
different.

gustavo
----- Original Message ----- 
From: "Michael Firstenberg" <msfirst at gmail.com>
To: <OpenHeart-L at lists.hsforum.com>
Sent: Monday, March 10, 2008 1:46 PM
Subject: Re: [HSF] endocarditis


> Planning on mechanical support for a bailout in a septic patient tends to 
> be
> a bad idea.  He may not get better in the time that you have the pumps in
> (although we have had shortterm pumps in for 2 months), longer term 
> devices
> will get infected.  Active/uncontrolled infection is a contraindication to
> long-term mechanical support (in fact we had someone in the OR for a 
> salvage
> LVAD Saturday in whom as we were about to make incision the micro lab 
> called
> about positive blood cultures - we backed out).  We recently also had an
> endocarditis case come out on ECMO/VADs for a week or two - bad EF to 
> start,
> but after a lot of work he got better.  The key is A LOT of ICU care with 
> an
> experienced team.  The other problem is, what is the next step after
> mechanical support?  Will this patient ever be a transplant candidate by 
> you
> or anyone else?  I would do whatever I could to get him out of the OR
> without mechanical support even if that means lots of Levo, Dobutamine, 
> Epi
> (some people love milrinone - but if he is always vasodilated as septic
> patients tend to be, then you will never get his pressure up), inhailed
> nitric.......but if the heart is dead and that is your only option, then
> like I keep saying - was it over when the Germans bombed Pearl Harbor?
>
> I think you may be amazed at how much a young heart will tolerate.
>
>
> On 3/10/08, Hgrmd at aol.com <Hgrmd at aol.com> wrote:
>>
>> Gustavo,
>> I sincerely hope I'm wrong about your patient.  Good  luck.
>>
>> Hal
>>
>>
>>
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