AW: [HSF] endocarditis-Vom Firstenberg

[Tea Acuff]

You certainly appeal to one of the world's foremost but unfortunately late authorities.

Not to worry. The facts of life are only slightly less confounding than its meaning. maybe i have that backward...

tea


----- Original Message ----
From: Michael Firstenberg <msfirst at gmail.com>
To: OpenHeart-L at lists.hsforum.com
Sent: Tuesday, March 11, 2008 8:11:26 PM
Subject: Re: AW: [HSF] endocarditis-Vom Firstenberg

Tea, Hal...... help me out here.......

http://www.youtube.com/watch?v=rtP3whUbgZE&feature=related



-m




On Mar 11, 2008, at 8:38 PM, Dr. Roberto Battellini wrote:

> ...when the Germans bombed Pearl Harbor???...and the Japanese  
> London???
>
> -----Ursprüngliche Nachricht-----
> Von: openheart-l-bounces at lists.hsforum.com
> [mailto:openheart-l-bounces at lists.hsforum.com] Im Auftrag von Michael
> Firstenberg
> Gesendet: Montag, 10. März 2008 17:46
> An: OpenHeart-L at lists.hsforum.com
> Betreff: 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 &
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