Really bad day - page 2
Hi, guys-need some TLC Ive been precepting in an open heart unit and have had few hearts. Enough to get my confidence up I guess. yesterday I had a triple bypass with aortic valve replacement. He... Read More
Nov 12, '10Agree 100%. Tricky open hearts are my favorite patients. IMO theres not really any other challenge like it in nursing. You can get sick patients that are going to die in any ICU, but a sick open heart who may be experiencing ANY type of shock imaginable at any given time, just makes them #1 in my book.
Nov 13, '10As an update. Patient experienced right sided heart failure(hence the high CVP), had an emergency IABP placed that night, avoided CRRT by a hair. And the best thing is he transferred to tele yesterday. Go, OH team. I was soo glad to see him survive.
Nov 18, '10Was your patient pacing in DOO, or ASYNCHRONOUS? This would be my bet for the cause of the patient's arrest, given that you said the patient had no underlying rhythm. I never, ever trust that the patient has _NO_ rhythm at all under the pacer, and so I switch them generally over to an inhibit mode of pacing, either DDD, AAI, or VVI if they come out in DOO. Even if your patient had no rhythm coming off pump in the OR, that does not mean that they will forever have nothing under there. In fact, quite the opposite, they will likely regain a rhythm at some point. DOO is really only good for either an extremely controlled environment (like the OR, with pump standing by), or an emergency when you can't get a pulse otherwise.
As I'm sure you know, the danger with asynchronous pacing is having a the pacemaker trigger another beat during ventricular repolarization (R on T phenomenon) which can cause Vfib/Vtach arrests. Since it happened right when the other nurse adjusted his rate, that is my guess as to what happened. Do you remember the pacing mode being used?