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Management of post-cath complications

Hematoma/bleedApply direct pressure to the artery, often directly above the site of the hematomaCompress artery against pelvic brim (between ASIS and pubic symphysis)Send for help asap (cardiology fellow oncall)Stat CBCAssess patient's vitals and peripheral pulses. Tachycardia/hypotensionAs

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Management of post-cath complications

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    1. Management of post-cath complications

    2. Hematoma/bleed Apply direct pressure to the artery, often directly above the site of the hematoma Compress artery against pelvic brim (between ASIS and pubic symphysis) Send for help asap (cardiology fellow oncall) Stat CBC Assess patient’s vitals and peripheral pulses

    3. Tachycardia/hypotension Assess groin site for active bleeding/hematoma Assess for dullness in bilateral flanks Large quantities of blood can be hidden in abdomen, thighs and flanks Stat CBC, coags and abdominal CT r/o RP bleed stop heparin/IIbIIIa in consult with cardiology fellow (emergent echo, etc.)

    4. Persistent/New Chest Pain Check ECG, cycle troponins, examine patient DDX: IST, microvascular injury post-PCI…GERD, musculoskeletal, etc. Rx guided by ECG changes Careful hx is crucial (characterize pain and correlate w/current and prior ECGs, response to Rx (SL TNG), prior history Monitor hemodynamic status

    5. Rising Creatinine/Decreased UOP DDX: embolic process, pre-renal azotemia, contrast nephropathy (~2 days post-procedure), cardiogenic shock (poor forward flow), sepsis ?IABP, if so concern for renal ischemia r/o infection, ?febrile->send Cx’s May give trial of IVF, HCO3- protocol, mucomyst (600 PO BID x day prior to and after procedure) Consider RHC if persistent hypotension and uncertain CO and volume status

    6. Altered Mental Status/Changed Neuro Exam DDX: CVA (embolic or hemorrhagic), metabolic, delerium, medications, infection STAT labs (CBC, Coags, Chem panel, LFT’s) Consider STAT head CT r/o ICH STAT Neuro consult for new CVA Serial neuro exams UA, BCx/UCx/SPCx, especially if febrile

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