48 yr old male has open hrt surgery has kidney and liver fail,developed burnt like chars on hand and feet why?

Question

My husband has been in criticle condition for the past 18 days now I understand about the liver and kidneys failing as part of the risk with open heart procedures, what I dont understand is why are his feet and one hand black and seems to have a charred like appearance. No one seems to beable to give me a straight answer, I wonder if I sould take this to another level? Was it human error? Was it medication? I dont understand, how does a strong, vital and otherwise healthy young man go in for a risky yet very common procedure and wind up looking as he does, he is on a trach and unable to move, talk or function up to this point. How was this possible, he's confused I'm confused I hope there is someone who can shed some light on this - also his extremities are very pain full and there are blisters forming. Thank you for your responses.

I'm sure he had to be shocked as he had aortic valve repair and replacement and well as a quad bypass his aortic valve was so small that it is vertually unheard of and therefore they do not manufacture replacement valves that small so the surgeon was left with a dillema as to what to what had to be done they had to cut and open the valve till it was big enough to fit the replacement valve then they had to repair that using pig tissue all of that took the time of what the whole procedure should have normally been. so all and all he was on the bypass machine for 12 hrs and they were unable to get his heart pumping again. when the surgeon finally got the heart going he had to have a pump do the work that his heart would have otherwise done. He is no longer on that pump, but still many complications.

My husband is now a candidate for amputation,as a result he will lose three fingers on his left hand and all ten of his toes.Because he has wet gangren,this type is bactirial and very dangerous,only occurs when an open wound is present. I know there were no wounds when he went in there.Also is it common practice to switch the IV site during a procedure of this magnitude? IV for fluids and blood gases were set in the left hand,when he came out they were relocated to the right hand.As far as I'm concerned somebody messed up big time,and the only person who knows for sure, was in that OR on June 9th. Everytime I ask for an answer to my why and how, I get the run around.Iam very pleased however with the quality of care that he is receiving, but this should have never happened. In the four weeks that I have been there I have seen at least fifty open heart patients come and go from that floor both young and old, and none have even come close to being in the condition that my husband is in.

Answer 1

If your husband has been on IV medications, called vasopressors, to keep his blood pressure from getting too low this can cause a decrease in peripheral circulation. The medications cause the vessels to constrict to keep the BP at an appropriate level. Because of this, the circualtion to the limbs, most often hands and feet, is inadequate. Most likely this is the reason his feet and hand appear this way. Unfortunately this is more common than we'd like to admit. Once this damage is done a lot of times there is no way to reverse it as well. The blisters may be forming due to excessive fuid in the tissues, called edema. And once again, fluids in higer volumes may be given to elevate his blood pressure as well. This is also one of those things that is necessary. If you have any questions please feel free to email me. I am a RN, working in a Cardiac Surgery ICU and I see this happen. Please, do not give up hope, I have seen people recover from situations like this. The best thing you can do is ask questions when you have them, and have the faith that your husbands physicians are doing their best to care for him. Best of luck to you and your husband!

Answer 2

Open-heart surgery requires the use of a heart-lung
machine and related equipment; the machine and equipment
together are known as a perfusion system and the perfusion
system is operated by a medical technician known as a
perfusionist. Essentially, the perfusion system consists of a
series of pumps and tubes that act as the patient's heart and
lungs while the heart is stopped during surgery. The pumps
transport blood and medications through the tubes to and from
various other pumps, as well as to and from the patient. It is possible that your husband was not properly perfused during surgery. It's also possible that it's just an unfortunate outcome to a risky procedure. I am in no position to say if something was done right or wrong, but if it was my loved one I would ask as many questions as possible. Since the extremities seem to be the most affected a perfusion problem seems most likely.

Try to find out if your husband had a stroke during the procedure, ask about hemiparesis, ask about everything. I wish someone here could give you an answer that would make you feel better but unfortunately the only one who knows for sure what happened was in that room. Just demand an answer.

Take care, and good luck

Additional info:
"Shocking" the heart would in no way cause that type of charred appearance on the extremities the only rational cause can be lack of perfusion similar to what happens in frost bite. Which hand was not aaffected, it would give a clue as to what and where a problem may have occured. (If one indeed did)

Answer 3

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Answer 4

so far most of what people have said is in some ways correct, none of it is grossly wrong. does he have diabetes? is it possible he could have been undiagnosed. i have seen this often in intensive care units. you are describing poor circulation to the extremities. when that happens in severe form then amputation is a result.

diabetes can be the culprit in all the symptomology you mentioned, and it does cause the charing look you mention, but so can infection, organ failure, septicemia, and other complications of complex surgery be implicated in his overall condition. each would have to be ruled out on its own if it hasnt already. he will probably come through it ok considering his age, and if he was in good health before surgery.

however it is now time to consider the what if's since he is not following the usual recovery for heart surgery.

1. if kidneys continue to shut down or fail he will need dialysis.
2. if he is on ventilator life support for a week or more doctors will start to consider doing a tracheostomy. not a serious issue but it will carry psychological ramifications for you and him.
3. if he starts having serious cardiac arrhythmias (those considered life threatening) then you have risen to another level of care, and interventions like swan ganz catheters, strong cardiac drugs.
4. if he gets jaundiced
5. if he has serious declines in oxygenation and lung function due to ARDS (adult respiratory distress syndrome, other names apply) then recovery gets much more iffy, and certainly longer term necessity.
NOW!! if all this is occuring, or begins to occur, i suggest you start to consider a living will at this time. especially IF your husband is able to help make the decisions in his care. if he is not then you need to consider the best alternative to his living or not living. the hospital has likely approached you relating to CPR, DNR, Chemical Code, Heroic Measures or any other euphimisms apply, but they have not counseled you in the IF's i have mentioned. believe me if he worsens these things will come up.
Dialysis is good in many cases but not a cure only a palliative treatment.
Tracheostomy is safe enough but renders the patient open to many an localized infection and deep lung infections; the same applies to swan ganz catheters, or any tube inserted into the body. they all get infected, infiltrated, and misplaced at times. the nurses, therapists, and CNA's do the best they can.
ARDS is the worst of the lot. It has a very high mortality rate, don't let the doctors tell you otherwise. yes it can be managed but 25 to 60% of patients with ARDS die.

if you want to learn more about a living will or a medical power of attorney shoot me an email: [e-mail]. i am certified through baptist hospital to counsel you in that area.

a closing thought. you said he has liver failure. be honest now. is he a heavy drinker? would you consider him an alcoholic. if so that may also explain some of his conditions. in general it sounds like he is undergoing routine post operative surgical procedures for his complications. by routine i mean the usual accepted treatments by certified board physicians. not to imply that routine is just ordinary or not insightful.

this is a rocky boat your riding, get comforting help for yourself, medical people will be helping your husband. stress and fatique will get you down if you don't manage yourself.

Answer 5

Sometimes complications happen that can't be foreseen. You can't necessarily blame it on human error. I've seen many healthy people undergo heart surgery and have these things happen. Perhaps there was something underlying that no one knew about or he wasn't showing symptoms yet. As for the 'charred' look on his extremities, not sure about that. Did they have to 'shock' his heart at some time? Or could it be blood clots in those areas?

Answer 6

I am sorry to about your husband. Since your husband had a difficult surgery and they had difficulty getting his heart to pump after surgery, they probably had difficulty of maintaining cardiac output which will perfuse the vital organs of his body (like his brain, kidney and liver) . To maintain a proper cardiac output and blood pressure, they probably place your husband on vasopressors, An example of a vasopressor is Levophed which is a potent vasoconstrictor,One of its adverse effect is tissue necrosis with extravasation

He also has some blisters from edema or third-spacing, probably from low albumin level ( a type of protein in our body) since he has liver failure.

If you have any questions about your husband's condition, please ask the doctors involved in his care or request a conference or meeting with them, I am sure the nurses can coordinate this meeting between you and your husband's physicians. Also, please make it a point to ask the nurses what is the plan of care for your husband each time you visit him.

Answer 7

Wow! I am really sorry what has happen to your husband.

My wife's father had his first heart attack at age 35. He has 9 total so far. He is now age 72. He got thru all of them by being angry and mean, not afraid. Fear takes away your strength.

The darkness in his feet and hand sound like poor blood circulation. Is the hospital checking his circulation and his oxygen levels in his blood. Keep talking to him, have others be with him, tell him to not deal with this with fear. If you can, massage his hands and feet to keep the circulation going. Especially his arms and legs.

Hope he gets better.

Answer 8

I couldn't just sit around and do nothing like my doctors suggested.

They didn't want me to do anything or to take herbs or herbal remedies, but I had to try something - they just wanted me to do dialysis!

This program allowed me to take control of my health. I went from Stage 4 to Stage 3 kidney disease.

It was easy to do and my BUN, creatinine and anemia are all in better ranges.

Reversing Your Kidney Disease?

Answer 9

Reverse Kidney Disease Naturally :
http://www.NaturallyGo.com/Support

Answer 10

his body is shutting down and it is ganegreen that is formed and they didnt want to tell you. i hope he pulls through and you both are in my prayers.