- purpose: recirculate blood flow to heart
- done if two or more coronary arteries are blocked, or maybe for LAD.
-stents go through femoral artery into coronary artery to open it up. CABG is open heart surgery. They bypass blocked artery via the saphenous vein.
- ICU Care: cardiogenic shock. Give positive inotropes (ctx), vasoconstrictor (norepinephrine), volume (IV fluids, albumin), insulin infusion (manage stress response). Lines will be pulmonary artery catheter, arterial line, epicardial pacing wires, ventilator (4 hours), 3 chest tubes. In ICU for 24 hours.
- PCU care: "Rehab" up for meals, walking 4x/day, surgical wound washed with chlorhexidine, sternum is a broken bone that will take 6-8 wks to heal
-sternum precautions: use thighs and legs rather than arms to get off chair, don't reach up to comb hair, don't use pecs basically, don't lift more than 5 pounds (no vacuuming, no lifting gallon of milk), no driving, no passenger sear
- risk is A-fib with RVR (BB once BP is stable), DVT (blood thinner), pneumonia (ambulate, IS)
-CABG risk: hypovolemia --> gradually warm patient with warm blankets, bear hugger, cover head
-dysrhythmias --> bradycardia, A-fib with RVR
- usually placed in radial artery
- provides constant blood pressure reading
- will always be red
- top line S bottom line D
- indicated for ABGs, vasopressors, HTN, vents, ARDS, shock
- NRSNG: Allen's test to ensure ulnar artery can perfuse hand when arterial line is blocking radial (can only do this before placement), strict sterile technique, good for 7 days, antimicrobial patch to help protect it, change dressing if not intact, Check pulses and compare to other side once already placed
Fix acid base balance, manage electrolytes, try to remove volume.
CRRT: Removes fluid and solutes slowly, for medically unstable patients. Used to maintain fluid balance and pH. Used in: fluid overload, acute renal failure, chronic renal failure, electrolyte imbalances, drug overdose. Mimics kidney. Cr should go back to normal. 24 hr per day therapy. 95/60 = MAP 65. To see if it's effective, want decrease in weight, normal Cr, decreased edema,
HD: Removes fluid, cleanses, and returns to body
- Shock that occurs when there is a block to blood flow in the heart or great vessels, causing an insufficient blood supply to the body's tissues.
- decreased preload, ventricles are being strangled, pulse pressure becomes narrow
- tension pneumothorax: absent breath sounds, trach deviation. Treat with fixing the cause, needle aspiration and then CT
- PE: chest pain, SOB, cough, increased WOB, increased HR, fever, hypotension, crackles, bloody sputum, feeling of impending doom. What's the HR? What's the BP? Higher HR and lower BP is very bad for right ventricle. Do echo to assess strain on right ventricle. Maybe heparin, maybe tPA, maybe ultrasonic breakup
****Look for narrow pulse pressure ****
close Systolic and Diastolic
- life threatening allergic reaction
- circulatory failure : massive dilation --> hypotension, release of vasoactive mediators, and increased capillary permeability (3rd spacing)
- respiratory distress: laryngeal edema and severe bronchospasm
- sudden dizziness, chest pain, incontinence, lip swelling, angioedema, wheezing, stridor, flushing, urticarial, pruritus, anxiety, tachycardia, hypotension, n/v/d, abdominal cramping
- give EPI to bronchodilator airways and vasoconstrictor vessels. probably need to add volume. Can give H1 or H2 blocker, corticosteroids. Epi supports BP and airway. Epi SEs: tachycardia, increased BG. evaluate breathing and BP
increased HR, normal to low BP, widened pulse pressure, skin is warm and flushed bc fever, confusion, oliguria, increased CO increased CI and increased SVO2 due to vasodilation, decreased CVP, decreased PAP, decreased PAOP decreased SVR
septic shock, decreased BP and PP and CO and SVO2, skin is cool and pale, hypothermia, anuria, positive blood culture
don't get caught up in hemodynamics
- pt ultimately has decreased CO
- decreased BP
- decreased renal perfusion --> increased BUN/Cr and decreased UO
- pulmonary congestion
-dyspnea, orthopnea, paroxysmal nocturnal dyspnea
-increased HR, increased RR, crackles, JVD, edema, ascites
- increased PAOP and CVP
- maintain CO
- this will continue perfusing organs
-O2, sit pt up right high fowlers, dangle legs to decrease venous flow back to heart, cardiac monitoring, UO hourly,
- if O2 does not work then we need to BiPAP (pt does not work as hard during exhalation like in CPAP)
- PA catheter (if PAOP is 19, then we must suspect LSHF. If CVP is elevated, RSHF).
- ultrafiltration : sort of like CRRT except not removing toxins