A young gentleman operated for Avr
.to appraisal 2023
dated 25.07.2023
I had joined my night duty that day. patient age 50 operated for AVR today was extubated and stable in bed .
he had taken some bread slices to eat along with water. suddenly he developed breathlessness and saturation fell down . prompt decision taken by anaesthesiologist on call, re intubate patient. Urgent TOE showed collection of fluid around left ventricle and flexible bronchoscopy was some secretions without any solid food residue. otherwise tracheal tree was normal. Chest x ray was congested. Family update was done.
haemodynamically patient was unstable and saturations were not climbing up. decision was made to open the chest and review.
on opening the chest there was no collection causing tamponade . serous fluid 1000 ml drained from left pleura.
serous fluid kept recollecting in left pleura.
heart contractility was good .
decision taken to put patient on bypass and aortic and venous bypass was established after giving heparin. patient kept on bypass while partial ventilation was done.
secretion from endotracheal tube were kept on pouring secretions. Lactate were climbing up.
contacted help at Papworth hospital for veno venous ecmo .
helped arrived at 7 am and patient shifted to Papworth hospital for further management .
learning lessons: quick decision taken to reintubate patient.
decision to shift patient to theatre was quick. In theatre free discussion with everyone lead to conclusion that we need to put patient on bypass giving rest to lungs.
Team ECMO contacted and decision made in the best interest of patient. sometimes wait and watch is the best policy
Patient was stabilised and sent back to basildon to recover and discharge home
