Term
| Risk facotrs for complications post cardiac surgery: |
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Definition
Older than 65
BSA
emergent procedure
Smoking
preexisting preoperative comorbidities (renal dysfunction, COPD, diabetes, AMI,
CABG
Low EF
Pulmnoary dysfunction
cardiogenic shock
anemia
new onset A Fib
Preop IABP |
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Term
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Definition
Decreased UO, slow cap refill, increased HR, decreased BP
can be from cardiac fxn, dysrhythmias, bleeding, volume, decreased ventricular compliance, inflammatory response |
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Term
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Definition
Volume/pressure in heart at end diastole
CVP and PAWP
Bleeding = treat with FFP and cryoprecipitate
No Bleeding - LR, NS
Goal MAP 60-90 |
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Term
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Definition
Age, preexisting heart disease, obese, CPOD, Stroke, fever, pain, anxiety, Enlarged heart, poor myocaridal protection during CPB, E- imbalance, decreased Ca, surgical disruption of conduction, hypothermia
Atrial most common, up to 60%. can comprimose filling of ventricles
TX: control or convert rhythm |
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Term
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Definition
decreased ventricle compliance exacerbated by ischemia and edema from reperfusion injury
TX: inotropic agent at low dose |
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Term
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Definition
PUlmonary disease, OSA, Mitral valve disease, RV hypertrophy, aortic disease...leads to decreased filling of LV, and decresaed CO.
TX: Optimize preload (volume administration), reduce RV afterload (low PVR), improve RV contractility, and mainatin SBP. |
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Term
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Definition
Sudden decrease in CO
Narrowing pulse pressures
fluctuating MAP
muffled heart sounds
increased CVP or equal to PAWP
increasing need for inotropes
EKG changes
sudden oliguria
sweaty, anxious, pale
Dyspnea
LOC change |
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Term
| Risk factors pulmonary dysfunction after cardiac surgery |
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Definition
General Anesthesia, Paralytics, Narcotics, Supine position: upward shift of diaphragm, chest wall relaxation, decreased breathing drive
CPB: pulm edema, inflammatory response causing leaking, decreased surfactant production and alveolar collapse
Cooling for myocardial protection
sternotomy incision and CTsplinting; reduces breath depth
Incisional Pain: decreased rep muscle use
Age
Obese
Diaphragmatic injury
smoking history
COPD, HF |
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Term
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Definition
Lung collapse due to diaphragm discplacement in a sternotomy. The lack of lung movement while on CPB, high O2%.
Increased risk of infection
TX: high PEEP, IS, chest physiotherapy, vigorous toileting, early ambulation |
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Term
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Definition
Fluid in pleural space
HF, pneumonia, embolism, Hemothorax, erosion of Central venous catheter
DX on chest radiographs. Typically on left side side, most resolve on their own, being reabsorbed by the body.
Symptomatic and those involving more than 25% may require thoracentesis |
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Term
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Definition
Air trapped in pleural space; more with each breath. Collapses lung, then trachea deviates away, then other lung and heart become affected
Causes: regional block, airway instruments, central line placement
S/S: Increased Peak pressure, decreased expiratory pressure, increase in End Expiratory pressure, decreased breath sounds, JVD, trachial deviation away from collapsed lung
TX: CT to drain |
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