[HSF] endocarditis

[Prasanna Simha M]

Why ?
Prasanna

On Tue, Mar 11, 2008 at 5:52 AM, Tea Acuff <tacuff at swbell.net> wrote:
> He is lucky he is not 8!
>
>  tea
>
>
>
>  ----- Original Message ----
>  From: gustavo abuin <gabuin at intramed.net>
>
> To: OpenHeart-L at lists.hsforum.com
>
>
> Sent: Monday, March 10, 2008 4:22:16 PM
>  Subject: Re: [HSF] endocarditis
>
>
>  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
>  >>
>  >>
>  >>
>  >> **************It's Tax Time! Get tips, forms, and advice on AOL Money &
>  >> Finance.      (http://money.aol.com/tax?NCID=aolprf00030000000001)
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-- 
Prasanna Simha M