best book: Manual of Perioperative Medicine by Bojar
Back to topPost-CABG
what was bypassed? discrete lesion vs. diffuse disease
what was the graft material? art vs. vein, pedicle vs. free
Looking for MAP 70-80 and DBP>50
First 6 hours, need CI>2.0
Hb 8.0
Fix acidosis
CVP is actually a good monitor of RV failure
Consider SWAN if EF<40%, Aortic Valves c CABG, Mitral/Tricuspids, CHF/Cardiomyopathy, Jehovah’s pts
Pressure Failure
Aortic Stenosis
AV synchrony is key
HR 90-100
Give Volume
Volume Failure
Mitral Valves
More tolerant of tachycardia
Give fluid until pulm diastolic bumps 3 points
2-4 liters
Acute Graft Closure
Get a 12 lead, look especially at t-waves
Post-Operative Bleeding
Blood climbing the chest tube against gravity is bad
Tachycardia
Amio 150 mg q 30-60 minutes up to 900 mg/day. Don’t bother with the drip
Flutter-needs dilt, not amio
Ventricular Fibrillation
It is sick coronary until proven otherwise
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Left Ventricular Assist Devices (LVADS)
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ACLS for Post-Sternotomy Patients
Guideline Document for ACLS for CSICU
Back to topTAVR / TAVI (Transcatheter Aortic Valve Implantation and Transcatheter Aortic Valve Replacement)
for severe aortic stenosis
TTE/CT Scan/Coronary Angiography as prescreen
Back to topSurgical Aortic Valve Replacement (SAVR)
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