SCCM Podcast SCCM Pod-128 Patient Management After Cardiac Surgery
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May 20, 2010 In this engaging discussion, Dr. Anthony Carlese, a leading authority in cardiothoracic care, shares his insights on managing patients post-cardiac surgery. He highlights the intricacies of handling complications like vasoplegia and the role of vasoactive medications. The conversation also explores challenges related to acute graft closure and the importance of diagnostic precision. Dr. Carlese emphasizes communication among the care team and innovative device management to enhance surgical outcomes, ensuring that education plays a pivotal role in critical care.
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Key Early Post-CABG Priorities
- Immediately after CABG, carefully understand the intraoperative course from the cardiac surgeon and anesthesiologist.
- Focus on acute graft closure, bleeding, vasoplegic state, and arrhythmias as primary concerns.
Recognizing Acute Graft Closure
- Acute graft closure post-bypass often shows specific ST segment elevation on a 12-lead EKG rather than telemetry.
- Hemodynamic instability or ischemic arrhythmias hint at acute graft problems needing urgent catheterization and possible stenting.
Managing Postoperative Bleeding
- Monitor chest tube drainage closely; persistent bleeding over 200 cc/hour for 2 hours merits surgical re-exploration.
- Differentiate anatomical surgical bleeding from coagulopathic bleeding and coordinate with surgeons early.