MANAGEMENT OF HYPOTENSION AND LOW CARDIAC OUTPUT in Cardiac Surgery PATIENTS

Posted by e-Medical PPT Monday, December 30, 2013
Postoperative hypotension:
Hypovolemia (blood loss anemia, polyuria, 3rd spacing)
Low SVR / vasoplegia
LV systolic dysfunction
LV diastolic dysfunction
RV dysfunction
Pericardial compression
Rhythm disturbance
Withdrawal of vasoactive medications

Stepwise approach to diagnosis:

Confirm the presence of hemodynamic instability
Ensure vasoactive drugs are being delivered
Targeted physical exam
Fluid challenge, inotropic support, cardiac pacing
Obtain ABG, CXR, EKG
TEE if cause of hypotension remains unclear

VASOPLEGIC  SYNDROME
Risk factors:

Prior treatment with ACE-inhibitors
Prolonged CPBP
Low ejection fraction
Early on-cardiopulmonary bypass hypotension
Septic endocarditis
Transfusion of RBC, FFP, platelets

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