The case Twenty-nine-year-old Anita Heart (5 feet 2 inches, 65 kg) comes to the operating room (OR) for a heart transplant. After giving birth to her baby, she develops peripartum cardiomyopathy and is ready to sign the adoption papers for her child, when she finds out that a transplant has just become available. You take her to the OR and insert an awake arterial line and induce and intubate her. You decide to line her up and perform a transesophageal echo. Her baseline data are stable: heart rate in the 50s, blood pressure in the 100s (50s PASP [PADP 48/20s]), and CVP 10–15. The case proceeds, and after you come off pump and give the protamine, the cardiac surgery fellow asks her attending if the right ventricle (RV) is supposed to look so large and bulky. The cardiac surgeon looks across the drapes at you and screams at you to do something fast! Save the RV, she says! Patient care Residents must be able to provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health. Make informed decisions about diagnostic and therapeutic interventions based on patient information and preferences, up-to-date scientific evidence, and clinical judgment. Treatment of right ventricular failure is aimed at increasing forward flow as well as avoiding additional insults to the right ventricle. This can be managed by decreasing any outflow obstruction, that is, pulmonary hypertension that may be present.
|Original language||English (US)|
|Title of host publication||Core Clinical Competencies in Anesthesiology|
|Subtitle of host publication||A Case-Based Approach|
|Publisher||Cambridge University Press|
|Number of pages||4|
|State||Published - Jan 1 2010|
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