HeartRN80
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:yeah:Thank you rikard for the article. It was very helpfull...in fact I am going to print it out and take it into work.
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I like the idea about the SIRS and I think that the surgeons only put in the IABP as a last resort. Because as you said the patient didn't need any afterload reduction, however the IABP can help increase the blood flow to the coronary arteries...maybe that was the thought behind it. We did a stat echo after the IABP no rupture or major abnormalities.....
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To begin.... My CVP 16 was with a PAWP of 28. I had obviously tried fluid before flogging a sick heart with pressors (Crytalloid, colloid, and Blood Products). I do understand what the SVR is and means.....what I was asking is WHY was my patient soooooo dialated and non responsive to fluids and pressors. I had a 3 month oreintation before recovering hearts on my own. I also had my charge nurse and fellow co workers in the room to see if they could see a piece of the puzzle I was missing during this recovery. Although I appreciate a response to my question, I have to admit that I am rather offened by your tone and implications of my ER nursing background I was seeking some supportive advice about a patients situation, not an assesment of my nursing skills.
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I have recently transfered to a CCU after doing ER nursing for 3 years. I had a fresh open heart patient the other night. The patient came back with a CO 14.6 and a CI 7.1 with an SVR 246, and a SBP in the 80's..... this was on 3 mcg of dopamine and 8 mcg of EPI. Throughout the night I had the pt up to 10 mcg of EPI, 200 mcg of NEO, 3 mcg of Dopamine, and 0.04 units an hr of Vassopressin....... To get me to an SVR of 496 and an SBP crashing in the 70's. Needless to say we did an emergent IABP at bedside. Now for my questions.... why couldn't I get an SVR??? My white count actually decreased throughout the night going from 22 to 18, kinda ruling out sepsis. My patient was an emergent CABG so I if anything I would actually expect cardiogenic shock with a high SVR???? Just looking for some ideas from experienced CCU nurses...Thanks!! Melissa