sobota, 9 stycznia 2010

Cardiogenic shock - case study.

Case study of Cardiogenic Shock.

22. December 2003, Mr. Fincher Grand beach Regional admitted complaining of chest pains and shortness of breath. Cardiac catheterization was performed and another vealed ejection fraction (EF) of less than 20% of the infe-RIOR wall myocardial infarction, multi-vessel disease include hooks completely closed, the left anterior descending and right coronary artery. Stenosis were also found in the left and diagonal arteries. His past medical history, including hypertension, diabetes and smoking. He was classified as IIIB of the New York Heart Association (NYHA). Mr. Fincher was a high-risk surgical candidates and intra-aortic balloon pump (IABP) was inserted. He was at the Medical University of South Carolina (MUSC) in Charleston, South Carolina, airs on Christmas Eve. ˛ For admission to Musc patient hemodynamically stable despite cardiac index 1.8 l / min / m. Dr. Jack Crumbley posted Patients Coronary Artery Bypass (CABG) procedures with possible insertion of a VAD. Mr. Fincher was taken to the operating room on December 26, 2003, for a CABG x 5. After several attempts were made to wean from cardiopulmonary bypass (CPB), bi-ventricular support (Bi-VAD) was initiated with AB5000™ Ventricles. Total time on CPB was 275 minutes with a cross-clamp time of 110 minutes.

While on CPB, 36 French cannula was placed on obtaining inter-atrial groove with 10 mm Hemashield ® graft to the aorta on the left side support Deputy ge. On the right side were combined with 36 Fr cannula cannulated yield the right atrial appendage and the pulmonary artery graft. Patient's sternum was closed, and heparin was filmed entirely in common full dose of protamine, IABP was in or is canceled and vasoactive drops were discontinued. Patients received four units of packed red blood cells (PRBC), five units of platelets and five units of fresh frozen plasma (FFP). Pump outputs are at approximately 5.0 liters / min stable. The patient was transferred to the cardiac intensive care unit (CTIC).

The patient was stable on the Bi-VAD support flows on 5,0-5,6 L / min (index> 2.3 l / min / m ²). Chest drainage is 10-15 cc / h, the activated clotting time (ACT) of 129 heparin, which was started on hospital protocol to 1500 units / hour TPN was initiated.

The patient remained stable, but reassured. There was no evidence of renal insufficiency with serum creatinine level of 1.0 mg / dl. Urine 75-100 cc / hour drop heparin was at 1500 u / h with ACT 192, well within the therapeutic range of 180-200 received. The patient worked for a heart transplant.

The patient remained hemodynamically stable with BiVAD flows of 5.0-6.0 L / min (index> 2.3 l / min / m ²). Heparin was adjusted to maintain the aPTT within the therapeutic range of 60-80 seconds. Attitude survey was conducted. On the right side shows no signs of recovery and minimal use of the left. The patient was still full support without any changes in its vital functions.

5. January 2004, the patient was transferred to the operating room EVAC ate clot from his chest. Prior to the opening of the sternum, the AB5000 console flows up to 2 l / min reduced. the patient is hemodynamically stable. 600cc clot was noted from the chest and native heart function has to be reasonable. AB5000 ™ chambers were successfully explantované.

PO day # 12: encouraging the patient remained stable and responds to aeration as a result of smoking. PO Day # 25: The patient received an automatic implantable cardio-verter-defibrillator (AICD) episodes of ventricu-lar tachycardia due to. Patient in the hall with his wife at his side ambulated. Left ventricular ejection fraction by echocardiography was 35%.

Patient discharged home. February 27, 2006, Mr. Fincher and four other survivors in the Celebration of Life Musc cere-mony honored. The ceremony featured the largest gathering of survivors and their families in the history of Abiomed. He was accompanied by his wife, looking for a great feel-ing. He lost 40 kg and stopped smoking.

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