Admitting an open chest pt - page 2
by volunteerpioneer 5,479 Views | 16 Comments
I am a newbie in the CT-ICU and part of my orientation is admitting all the fresh hearts. Yesterday, the case scheduled was CABG x3; but ended up needing an AVR and IABP in OR. and when receiving report they stated he was going... Read More
- 0Jul 27, '12 by umcRNWhen I heard how much nitric cost I almost stroked because we have kiddos that LIVE on it for weeks to months at a time. With infants and children we try not to whip out the big guns (flolan, romodulin) until everything else has been tried. For the most part we are able to wean them off it pretty easily so.e kiddos just latch on tho and don't want to let it go
- 1Jul 28, '12 by IHeartDukeCTICUWe just started using the CALS protocol (Cardiac Surgery Adv Life Support) which is a modified version of ACLS specific to CV/CTICU pts. Basically, if pt's meet certain criteria and they code, after 3 stacked shocks, we already start prepping the chest, the house officer (usually NP or PA) can open and either the other HO or the bedside nurse assists, all without a surgeon there.
It was presented at NTI a few years ago by another hospital in CA and adapted by our CTICU. Of course alot of training was involved and an open chest cart was developed. But there are a few studies out there (mainly from the UK) that have shown that in post-heart sx pt's that code, getting into the chest earlier has better outcomes.
Just think about regular ACLS: Do you really want to pound on a person who just had their sternum closed? Think RV puncture from ribs or sternal wires. Or what if they are actively tamponading? Opening the chest and evacuating while doing internal massage sounds much better
Also some of the drug doses are modified, i.e. no longer 1mg of epi... think about giving that to a fresh cabg who v-fib arrests... you get a rhythm back and then they blow a graft
- 0Aug 1, '12 by brainkandy87This thread is so cool. I know ICU nursing is definitely not for me, as I like my ER patient care length of a couple hours and getting the codes in through the door, but oh how I'd love to see something like this and all of the little toys we have to play with regarding it.
- 0Aug 4, '12 by crizzIv been in the CV/CICU for over 5 years now and seen 4 patients with open chest and only two make it. The last one was an AVR with endocarditis, came out with an IABP and immediately started on CVVHD. He was on Epi, Levo, Vaso, Dopa, and primacor. Couldn't raise his arm without his BP tanking. We had to go back in twice at bedside within 18 hrs post-op because of tamponade. 4 weeks later the pt is in rehab walking and doing just fine. Just goes to show us that our hard work does pay off and there could be good outcomes in the end.
- 0Aug 6, '12 by umcRNQuote from IHeartDukeCTICUThank god for NO residents in my CICU - teaching hospital yes, but residents do not do any rotations in my unit (not that first year fellows are any better but its a few months before they get to be on the unit by themselves)FYI... you know it's July when a open chest patient codes and the resident is trying to jump on the chest and do compressions, while we are all yelling at him to step away so we can get in. hahaha for real, true story a few weeks ago.