cddbme1

Thanks so much for your input. Here is the answer to your questions: Not on many meds: IV coumadin, zithromax (+ sputum culture) colace, lactinex ambien, oxycodone, something for depression, lasix Which brings me to another question: this pt has been insisting he has water on his lungs. lasix has been given intermittently but now 20mg QD. At home he was on 160mg lasix QD and Zaroxylyn every 3rd day (but needed it daily) Dr. keeps saying does not need more despite pump flow being up 6's, xrays show pleural effusion, I>O. Total weight up 10+ pounds since surgery. On Ventrassist. EGD did not show any ulcers, bleeds or other problems. Colonoscopy not done. unsure where bleeding was coming from in the lungs. Bleeding still occured with INR in 1's and on coumadin. Yes, center does a lot of VADs but I am new at taking care of them. This pt. participated in study, with VAD destination therapy. Thanks!

INR, nonresponse to coumadin therapy by cddbme1 Registered User Join Date: Mar 2009 Posts: 1 Patient: hx chronic at fib, CABG x2, cardiomyopathy, pacemaker, AICD. 7 weeks post op VAD with hx bleeding in stomach and lungs since VAD surgery. Coumadin therapy prior bleeds and post bleed have not produced increase in his INR. Coumadin 2.5, 5mg, 5mg, 7mg=inr 1.27; 1.06; 1.12, 1.04. Also hx 3 PICC lines; 2 clotted off. No other signs symptoms of bleeding irregularity other than platelets slowly dropping 400,000 to current 247,000. Stools + blood (probably old from stomach bleed) Everything else normal except pt has c/o of stomach and lower abdominal pain since surgery. Ileus resolving. Took 1 month for bowels to work. Bowels currently working but unable to get off NG tube d/t n/v. J-tube feeding successful at low rates but when rate up 50-70cc/hr GI symptoms get worse. GI symptoms vary to pinpoint pain LLQ near J-tube insertion, LLQ, RLQ abdominal fullness fairly consistent. Intermittent belching, flatus, Hyperactive bowel sounds now with lots of fliud present upon percussion, abd soft most of time even with fliud. NG drainage varies 450-1000cc/24hr. OU OK Please comment on coumadin/INR, Persistent symptoms of GI tract not emptying properly. MD's feel problem will resolve. Coumadin being given IV now. Several KUB's. No Cat scans or other tests. Pt on vent with trache (bleeding in lungs prior to trache) Coumadin and AC therapy stopped to get lung bleeding under control. Presently only streaks of blod in NG and ETT small amount bleeding.

Patient: hx chronic at fib, CABG x2, cardiomyopathy, pacemaker, AICD. 7 weeks post op VAD with hx bleeding in stomach and lungs since VAD surgery. Coumadin therapy prior bleeds and post bleed have not produced increase in his INR. Coumadin 2.5, 5mg, 5mg, 7mg=inr 1.27; 1.06; 1.12, 1.04. Also hx 3 PICC lines; 2 clotted off. No other signs symptoms of bleeding irregularity other than platelets slowly dropping 400,000 to current 247,000. Stools + blood (probably old from stomach bleed) Everything else normal except pt has c/o of stomach and lower abdominal pain since surgery. Ileus resolving. Took 1 month for bowels to work. Bowels currently working but unable to get off NG tube d/t n/v. J-tube feeding successful at low rates but when rate up 50-70cc/hr GI symptoms get worse. GI symptoms vary to pinpoint pain LLQ near J-tube insertion, LLQ, RLQ abdominal fullness fairly consistent. Intermittent belching, flatus, Hyperactive bowel sounds now with lots of fliud present upon percussion, abd soft most of time even with fliud. NG drainage varies 450-1000cc/24hr. OU OK Please comment on coumadin/INR, Persistent symptoms of GI tract not emptying properly. MD's feel problem will resolve. Coumadin being given IV now. Several KUB's. No Cat scans or other tests. Pt on vent with trache (bleeding in lungs prior to trache) Coumadin and AC therapy stopped to get lung bleeding under control. Presently only streaks of blod in NG and ETT small amount bleeding.