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OPEN HEART SURGERY

OPEN HEART SURGERY. BY NANCY JENKINS. Coronary Arteries. Left Main - “widow maker” LAD- supplies LV. If occlusion have anterior MI RCA- if have occlusion have inferior MI. PRE-OP TEACHING. Intra-op Events. hypotension cardioplegia cross clamping aorta cardiopulmonary bypass

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OPEN HEART SURGERY

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  1. OPEN HEART SURGERY BY NANCY JENKINS

  2. Coronary Arteries • Left Main • - “widow maker” • LAD- • supplies LV. • If occlusion have anterior MI • RCA- • if have occlusion have inferior MI

  3. PRE-OP TEACHING

  4. Intra-op Events • hypotension • cardioplegia • cross clamping aorta • cardiopulmonary bypass • heparinized

  5. CP Bypass

  6. http://www.nlm.nih.gov/medlineplus/tutorials/openheartsurgerywhattoexpect/ct079101.htmlhttp://www.nlm.nih.gov/medlineplus/tutorials/openheartsurgerywhattoexpect/ct079101.html

  7. Tubes after open heart

  8. Open heart surgery YouTube - Malpractice Medical Coronary Artery Bypass Graft (CABG) Surgery 3

  9. Post-op Appearance • mechanical ventilator-SIMV mode • hemodynamic monitoring- dec. CO • cardiac monitoringSVT and Afib common • mediastinal tube-100cc first hour to 500/24 • multiple IV sites and lines • pacer wires • foley-hourly output

  10. Assessment • vital signs • PAP • PCWP • CO • urine output • bleeding • fluid balance and neuro

  11. Complications • decreased cardiac output • cardiac tamponade • hypokalemia • Hemorrhage-replace cc for cc . 100 first hr. then 500/24 hours • neuro changes • resp insufficiency • infection and pain-dilaudid, splint incision. Offer pain med: percoset or vicodin q 4hr.

  12. Cardiac tamponade Paradoxical pulse is a pulse that markedly decreases in amplitude during inspiration. On inspiration, more blood is pooled in the lungs and so decreases the return to the left side of the heart; this affects the consequent stroke volume.

  13. Cardiac tamponade (influenced by volume and rate of accumulation) • Beck triad (jugular venous distention, hypotension, and muffled heart sounds) • Pulsus paradoxus is measured by careful auscultation with a blood pressure cuff. The first sphygmomanometer reading is recorded at the point when beats are audible during expiration and disappear with inspiration. The second reading is taken when each beat is audible during the respiratory cycle. A difference of more than 10 mm Hg defines pulsus paradoxus. • Cyanosis • No drainage from mediastinal tube

  14. Decreased Cardiac Output • decreased preload-need fluid • inc. afterload- need to dec. B/P(Nipride) • dec. contractility- need dobutamine • Arrhythmias- SVT and Afib common • (20-40%) have A fib and may have increased LOS

  15. Post-op Care Goals • Promote CV function, tissue perfusion and stablization of VS

  16. cont. • Promote respiratory function and sufficient oxygenation by promoting chest drainage and use of IS

  17. Goals • Promote fluid and electrolyte balance • Promote renal function • Promote rest, comfort, and relief of pain • Promote neurological function • Promote psych adjustment • Promote early movement and ambulation

  18. New Advances CARDICA C-PORT ANASTOMOSIS SYSTEMS For Beating Heart Surgery

  19. Robot Assisted CABG Robot - Assisted Heart Bypass with Cardiac Catheterization

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