Critical Care Scenarios Episode 20: Post-CABG emergencies with Kris Ramilo and Brendan Riordan
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Nov 29, 2020 Kris Ramilo, a Cardiothoracic ICU nurse practitioner at the University of Washington, teams up with Brendan Riordan, a cardiothoracic ICU PA, to delve into the intricacies of post-operative care following CABG. They discuss vital management strategies, including pain relief and the importance of timely extubation. The duo emphasizes recognizing and addressing cardiac complications like tamponade, and the crucial role of Advanced Practice Providers during emergencies. Their insights on patient monitoring and teamwork in high-stress scenarios are particularly noteworthy.
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Systematic Post-CABG Assessment
- When admitting a fresh post-CABG patient, do a systematic physical exam starting with chest tubes patency and cardiovascular status.
- Follow with respiratory, GI assessments and chest X-ray to detect unexpected effusions early.
Early Extubation Strategy
- Aim to extubate uncomplicated CABG patients as soon as possible, ideally within an hour if hemodynamics allow.
- Use short-acting pain meds during ventilation and transition to oral meds pre-extubation for comfort.
Early Tamponade Detection
- In low cardiac output with rising CVP and dropping SvO2 after CABG, suspect cardiac tamponade physiology.
- Check chest tubes for patency and clot; use point-of-care ultrasound to look for pericardial effusion urgently.