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Hemodynamic management

Physical exam and assessment

  • Assure that the endotracheal tube is in proper position and the patient has equal air entry bilaterally. Remember that tube displacement or pneumothoraces can occur or become apparent at any moment.
  • Verify that the patient’s oxygen saturation is adequate. Check the ABG results as soon as they are available.
  • Verify correct ventilator settings.
  • Check the initial hemodynamic readings (HR, BP, cardiac output and index, CVP, PCWP) and determine what vasoactive infusions the patient is on and at what rates.
  • Check the patient’s heart rhythm. Verify pacemaker settings if the patient is connected to one.
  • Check the chest and mediastinal drainage sumps to ensure they are patent and that the patient is not bleeding excessively.
  • Examine heart sounds. Listen for murmurs particularly if the patient has had valve surgery.
  • Check all peripheral pulses. Do repeated assessments if there is concern for acute limb ischemia or if the patient has a femoral arterial line or IABP in place.
  • Examine the abdomen.
  • Check pupillary reflexes. Do a more complete neurologic exam when the patient begins to awaken from GA.