BP drop in CABG

[fabiusgile]

I had a pt last week S/P CABG 2 wks prior with complications. who's BP dropped to 74/40 and was symptomatic cool clammy. Presented on tele NS- low ST. Called cardiologist got orders for 250ns bolus. some improvement on BP she dropped again. 2nd order of 250ns bolus. MD mentioned he thought he had dried her out to much because of pleural effusion. 2nd bolus didn't help. I put got an EKG A-fib nothing on tele (strip started with PVC) so looked funny. Got 2nd NS. updated MD of info. 3rd NS 250 bolus admit to ICU NO Dopamine tirate bp

What would you have done in this situation? Anything I can do to improve care if similiar situation comes up?

Come to find out they evacuated a 400ml clot in her heart that was pushing on her chambers (is that possible?) and did a pericardial window.

[nursej22, MSN, RN]

A portable CXR may or may not show an enlarged heart, but it would r/o pleural effusions. If the trapped blood was say, behind the heart, it wouldn't show up on a portable. An echo would necessary to locate the effusion/clot in order to evacuate.

I think in this the case the a fib was sort of a red herring because it wasn't really related to the primary problem. Yes, it can result in clots in the left atrial appendage, but it usually isn't a concern unless it lasts >48 hours.

And FWIW, it's AMIODORONE, not AMNIODORONE.

[CCL RN, RN]

Seems like the OP only wanted to be told that she did everything alright. Anytime somebody says something she doesn't approve of, then it's all bitterness and anger.

OP, any time you put something out there on the Internet, you aren't always going to get responses that coddle your ego. Sometimes you get the truth.

You know, the fact that you didn't understand that the clot was in her pericardium, in the same sentence as you saying she had a pericardial window, strikes me as an educational situation. I'd bring up your concerns with your educator.