My stepdad went into the hospital on Aug 24th to have open heart surgery (Mitral valve/Aortic valve replacement and coronary bypass). The surgeon was made well aware of his issues of poor circulation in his legs and previous strokes as well. My stepfather came out of the surgery and within a few days developed gangrene in his feet. The doctors determined he had developed Heparin Induced Thrombocytopenia and Thrombosis(HITT) which led to him having to have his legs amputated just below the knee. A few minutes prior to him being taken for the amputation the heart doctor came in and stated "we should have thought about this" in reference to his legs. A few days beyond this, we recieved a call stating that his blood pressure had dropped drastically and he was not going to survive. Sadly this did prove to be the case. We were told it is possible that a clot from his diagnosis of HIT had made it up to his heart. We have yet to have an autopsy to get the actual cause of his passing due to financial burdens. My questions are, would his heart surgeon have been in the wrong for not addressing his circulation issues prior to the surgery? And provided we are able to get the autopsy and it does come back as a clot from the Heparin we’re aware we’ll have that to work with. But if we’re not,even tho my stepdad has passed would we still have a case with the HITT leading to his amputations?
That is to say, assigned to their own room in the hospital so friends and family can visit, providing there is nothing immediately life-threatening?
Ms. D was a 79-year-old, morbidly obese (323 lb, 5 feet, 1 inch tall) Caucasian woman with an extensive medical and surgical history that included bilateral knee replacement several years previously. She developed large blisters (bullous skin reaction) that contained sero-sanguineous fluid. The blisters were disseminated over her body but were most prevalent on the arms, anterior upper chest (predominantly above the breasts), and anterior upper and lower legs. A wound ostomy continence (WOC) nurse specialist was consulted to evaluate and offer recommendations for treatment.
History. Ms. D was admitted to a subacute care facility’s critical care unit in the summer of 2003. She was transferred from the acute care setting following a month-long tertiary care hospitalization. Originally, Ms. D was admitted to the tertiary care facility primarily for congestive heart failure that did not respond to medical therapy. Cardiac catheterization revealed severe aortic valve stenosis and cardiomegaly. The patient was referred to cardiac surgery and had an aortic valve replacement (AVR) with a St. Jude mechanical valve. The surgeon had wanted to use a bioprosthetic valve but Ms. D’s body structure required use of a mechanical valve and subsequent requisite lifelong anticoagulation.
Ms. D’s postoperative course was complicated by a prolonged ICU stay for ongoing low cardiac output syndrome. She also developed respiratory failure and required a tracheotomy with mechanical ventilation. She had a Groshong catheter placed for IV therapy. In addition, she developed tachycardia-bradycardia syndrome and required a pacemaker. Subsequently, she developed atrial fibrillation despite cardioversion attempts and pacing efforts.
Because of the mechanical heart valve and the atrial fibrillation, Ms. D was started on intravenous heparin. Within a week, she developed severe thrombocytopenia; heparin-induced thrombocytopenia (HIT) syndrome was suspected. A HIT assay was positive for heparin-induced platelet antibodies. The heparin was discontinued. Unfortunately, gastrointestinal bleeding also complicated Ms. D’s postoperative course. She was started on argatroban to treat the HIT syndrome and required multiple transfusions. Per chart history, Ms. D’s subsequent anticoagulant therapy included enoxaparin sodium (Lovenox, Rhone-Poulenc Rorer Pharmaceuticals, Inc., Collegeville, Pa.) until a final progression to longer-term oral anticoagulation (warfarin). The exact temporal relationship of argatroban, enoxaparin sodium, and warfarin usage was not specified in the chart history (See Discussion).
On transfer to the subacute care facility, Ms. D’s diagnoses were listed as status post aortic valve replacement, sick sinus syndrome, cardiomegaly, status post pacemaker, atrial fibrillation, hypothyroidism, hypertension, hypercholesterolemia, and ventilator-dependent respiratory failure (VDRF). Her allergies were listed as heparin and heparin products.
So, EyeOpener, did you enjoying reading my casestudy about HITTS I had to write for JHU If you would like, I can post the rest since I know you love reading /stalking me and my post. I know that I am not only beautiful,ostentatious, and astute, and you have every right to envy me and my work, BUT you really should stop wasting your time on being jealous of lil ol’e me 
Nope R U Kidd, there is one dumb ass out there named EyeOpener who like to stalk me, read my post and then tries to hurt my feeling by saying something rude about the lenght of the post. I figured my lil friend would enjoy a 10 min read. Thanks, though
Ms. D was a 79-year-old, morbidly obese (323 lb, 5 feet, 1 inch tall) Caucasian woman with an extensive medical and surgical history that included bilateral knee replacement several years previously. She developed large blisters (bullous skin reaction) that contained sero-sanguineous fluid. The blisters were disseminated over her body but were most prevalent on the arms, anterior upper chest (predominantly above the breasts), and anterior upper and lower legs. A wound ostomy continence (WOC) nurse specialist was consulted to evaluate and offer recommendations for treatment.
History. Ms. D was admitted to a subacute care facility’s critical care unit in the summer of 2003. She was transferred from the acute care setting following a month-long tertiary care hospitalization. Originally, Ms. D was admitted to the tertiary care facility primarily for congestive heart failure that did not respond to medical therapy. Cardiac catheterization revealed severe aortic valve stenosis and cardiomegaly. The patient was referred to cardiac surgery and had an aortic valve replacement (AVR) with a St. Jude mechanical valve. The surgeon had wanted to use a bioprosthetic valve but Ms. D’s body structure required use of a mechanical valve and subsequent requisite lifelong anticoagulation.
Ms. D’s postoperative course was complicated by a prolonged ICU stay for ongoing low cardiac output syndrome. She also developed respiratory failure and required a tracheotomy with mechanical ventilation. She had a Groshong catheter placed for IV therapy. In addition, she developed tachycardia-bradycardia syndrome and required a pacemaker. Subsequently, she developed atrial fibrillation despite cardioversion attempts and pacing efforts.
Because of the mechanical heart valve and the atrial fibrillation, Ms. D was started on intravenous heparin. Within a week, she developed severe thrombocytopenia; heparin-induced thrombocytopenia (HIT) syndrome was suspected. A HIT assay was positive for heparin-induced platelet antibodies. The heparin was discontinued. Unfortunately, gastrointestinal bleeding also complicated Ms. D’s postoperative course. She was started on argatroban to treat the HIT syndrome and required multiple transfusions. Per chart history, Ms. D’s subsequent anticoagulant therapy included enoxaparin sodium (Lovenox, Rhone-Poulenc Rorer Pharmaceuticals, Inc., Collegeville, Pa.) until a final progression to longer-term oral anticoagulation (warfarin). The exact temporal relationship of argatroban, enoxaparin sodium, and warfarin usage was not specified in the chart history (See Discussion).
On transfer to the subacute care facility, Ms. D’s diagnoses were listed as status post aortic valve replacement, sick sinus syndrome, cardiomegaly, status post pacemaker, atrial fibrillation, hypothyroidism, hypertension, hypercholesterolemia, and ventilator-dependent respiratory failure (VDRF). Her allergies were listed as heparin and heparin products.
So, EyeOpener, did you enjoying reading my casestudy about HITTS I had to write for JHU If you would like, I can post the rest since I know you love reading /stalking me and my post. I know that I am not only beautiful,ostentatious, and astute, and you have every right to envy me and my work, BUT you really should stop wasting your time on being jealous of lil ol’e me
Nope R U Kidd, there is one dumb ass out there named EyeOpener who like to stalk me, read my post and then tries to hurt my feeling by saying something rude about the lenght of the post. I figured my lil friend would enjoy a 10 min read. Thanks, though
I am getting ready to start high school and I have really been thinking about my future lately. I have wanted to work in the n.i.c.u ever since i could remember. I know it would be a very intense and challenging job but also very rewarding. I would really like to find as much information as i can to see what it is like and what other people have to say about it. I know i want to work in the n.i.c.u but am having a hard time deciding if i would like to become a nurse or doctor in that medical field. I would like to find the difference of the job that a nurse or doctor would have in the n.i.c.u. i will take all the info i can get.
Copyright 2010 © terapiaintensivacali.com