Low BP in cardiac surgery patients. 1 st things first Zero all lines Swingy arterial line CVP Urine...
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Transcript of Low BP in cardiac surgery patients. 1 st things first Zero all lines Swingy arterial line CVP Urine...
Low BP in cardiac surgery patients
1st things first
• Zero all lines• Swingy arterial line• CVP• Urine output
– Beware osmotic diuretics
• Base excess• Are they warming up
• What inotropes ? escalating
BEFORE INOTROPES• Fluid
– Bolus– Legs up
• Rhythm– ECG, SR / AF, slow, fast, paced on ventricle, STs, ectopics
• Tamponade– CVP, BE, UO, temp, CXR, echo
• Bleeding– Drains, CXR, Hb
• Pneumothorax– CXR, examine, vent alarms
• Fight Ventilator– Paralyse, sedate or extubate
• If on ward what drugs– Beta blockers, ACE inhibitors, apha blockers, calcium channel blockers– Beware prostate alpha blockers and nicorandil for angina
What operation have they had?
• Any Valve – stuck leaflet, para valvular leak– Use stethoscope
• Mitral repair – ? Given way– Use stethoscope
• Aortic valve – adequate pre load, A-V synchrony, high SVR
• CABG – infarct, stunning, graft ok ? Re-graft ?IABP
Which Inotrope
• Ohms Law
• V=I x R
• BP=CO x SVR
• Simple terms• Low or high cardiac output, what is the PA pressure
• ARE THE ANKLE PULSES BOUNDING?
Inotropes• Atropine• Ca2+
• Adrenaline• Noradrenaline
• Dopamine• Dopexamine• Dobutamine• Isoprenaline• Enoximone• Aminophylline• Vasopressin• Methylene blue
What else
• IABP
• LVAD
• RVAD
• BVAD
Tamponade
Arterial Swing - Pulsus Paradoxus
Pneumothorax
Pleural effusion
Sinus bradycardia
Fast AF
Paced on ventricle
STs
Ectopics post inferior MI
Complete heart block