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You are here: Home / 03. Intensive Care / Cardiothoracic Surgical Intensive Care

Cardiothoracic Surgical Intensive Care

December 3, 2013 by CrashMaster

best book: Manual of Perioperative Medicine by Bojar

Post-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

 

Left Ventricular Assist Devices (LVADS)

 

ACLS for Post-Sternotomy Patients

Guideline Document for ACLS for CSICU

TAVR / TAVI (Transcatheter Aortic Valve Implantation and Transcatheter Aortic Valve Replacement)

for severe aortic stenosis

TTE/CT Scan/Coronary Angiography as prescreen

Surgical Aortic Valve Replacement (SAVR)

 

 

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Filed Under: 03. Intensive Care, cardiology


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