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Etiology of “medical” bleeding

Immediate post-op care

The resident should be present in the ICU when the patient arrives from the operating room to receive a sign-over from the anesthesiologist and the cardiac surgical team. During this period, the ICU nurses will be transferring the patient to the ICU monitors and checking all lines and infusions. The nurse will then do the initial set of hemodynamic readings. The Respiratory Technician will place the patient on a ventilator. Unless the patient is unstable it is best to stay out of the way of the nurses during this period, and wait until they are finished with their assessment before examining the patient.

History

Collect the following information from the anesthesiologist, surgeon, and the patient chart.

  • Patient background (age, sex)
  • Type of operation (CABG, valve, elective vs. urgent etc)
  • Indications for operation
  • Pre-operative cath report (vessels involved, LVEF)
  • Success of operation (completely or incompletely revascularized, difficulties, complications)
  • CPB time and aortic cross-clamp time
  • Ease of separation from CPB ( dysrhythmias, need for inotropes, pacing, etc). Difficulty coming off pump may imply problems with myocardial preservation or with the revascularization.
  • Current inotropes, vasopressors, or anti-hypertensives (if any)
  • Need for cardiac pacing
  • Use of Intra-aortic balloon pump (IABP), ventricular assist devices (VAD), or nitric oxide (NO).
  • Significant bleeding
  • Other significant co morbidity, with emphasis on those conditions that may alter the post-operative management or course (carotid artery disease, COPD, asthma, diabetes, renal failure, hepatic failure, etc.)
  • Pre-operative medications
  • Allergies