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 came on temp pacer fully paced-no underlying rhythm-complete heart block. Well he was very sluggish and difficult to keep pressures up, and his preloads were high due to his incompetent right ventricle(TEE showed).A nurse-not my preceptor, came by and said that if we upped the heart rate we might get better outputs and started to increase the rate 80 to 90. Immediately he went into VTach-Vfib. Had to shock twice, drugs, fluids wide open, pressures now in 300's then 80's, high preload, hh down 2 points but no tamponade or serious bleed.
I guess I am just replaying in my mind what happened or what I missed(many things for sure). I am questioning if she inadvertently hit pause as she had some problems unlocking the pacer, did he get too much fluids?Surgeon asked for a lot of fluids and milrinone/epi. I am exhausted and not even sure that Ill survive this specialty.
yes he did.
RCA/LAD and OM were grafted. I just dont understand why as soon as she touched the pacer-icreased by few beats he went in to VTach-Is it a coincidence?She is really beating herself up and I feel pretty bad as well. Oh, and something else is that he swung from resp.alkalosis to metabolic acidosis within 3 hours. CV patients are such puzzles.
thank you so much aCRNA hopeful-you have been a wealth of info
Last edit by Zaphod on Oct 26, '10