I don't write much on this forum, but I thought I could get a lot of interesting feedback here. I have two questions: The first one is does anyone know why a heart patient is at risk for A- fib post op, and how is this risk related to dehydration post op- it seems to me that these CABG patients 3 days out or so get dry and go into A- fib unless they are put on antiarrhythmics. So on the pathophysiology level what's happening here? Why is electrical conductivity not functioning correctly? It doesn't strike me to be mechanical, please share your thoughts.
The second question is about the post of CABG patient I had. 3 days post- op She seemed dry (low UO <20/hr), I know she wasn't perfusing the kidneys as well because we were beta blocking her for the first time so her pressures were usually 180's and now were 130's but still she just seemed dry to me. Maintenance fluids were going at 50ml/hr (D5W), MD was aware of the low UO and not concerned "she's going to go into ARF" was his response. BUN and Cr were still good. On the flip side of the coin, she had rales and her lungs were wet, X-ray confirmed this and the MD ordered 40 of lasix and then 4 hours later 4mg of bumex.
The problem- one hand she is wet in her lungs, but dry intravascularly. Sure I could give her albumin and then lasix and try to draw the fluids out of lungs and out... but the situation made me nervous. She had no central lines and no CVP Aline etc.
I gave the 250 ml albumin, then 40 lasix 4 hours later 4 of bumex (seemed like a lot) she responded ok, 400 ml urine out in 12 hours- not great. Then she went into a fib- PVC's and then had 5 episodes of v-tac in maybe 15 minutes time. I started the Amiodarone gtt and felt that her cardiac events were related to her fluid status. Labs were all ok. K. MG, Ca, etc. b/p was dropping during the A fib and V fib episodes.
I feel like I missed the big picture here.
Please share your professional take on this- could I have done anything to prevent the cardiac episodes.
Thanks for your time
Luv Your Nurse
May 8, '07
Did the pt have chest tubes or pacer wires post op?
Last edit by BBFRN on May 8, '07