1. Low BP in cardiac surgery patients

2. 1 st things first Zero all lines Swingy arterial line CVP Urine output –Beware osmotic diuretics Base excess Are they warming up What inotropes ? escalating

3. BEFORE INOTROPES Fluid –Bolus –Legs up Rhythm –ECG, SR / AF, slow, fast, paced on ventricle, STs, ectopics Tamponade –CVP, BE, UO, temp, CXR, echo Bleeding –Drains, CXR, Hb Pneumothorax –CXR, examine, vent alarms Fight Ventilator –Paralyse, sedate or extubate If on ward what drugs –Beta blockers, ACE inhibitors, apha blockers, calcium channel blockers –Beware prostate alpha blockers and nicorandil for angina

4. What operation have they had? Any Valve –stuck leaflet, para valvular leak –Use stethoscope Mitral repair –? Given way –Use stethoscope Aortic valve –adequate pre load, A-V synchrony, high SVR CABG –infarct, stunning, graft ok ? Re-graft ?IABP

5. Which Inotrope Ohms Law V=I x R BP=CO x SVR Simple terms Low or high cardiac output, what is the PA pressure ARE THE ANKLE PULSES BOUNDING?

6. Inotropes Atropine Ca 2+ Adrenaline Noradrenaline Dopamine Dopexamine Dobutamine Isoprenaline Enoximone Aminophylline Vasopressin Methylene blue

7. What else IABP LVAD RVAD BVAD

8. Tamponade

9. Arterial Swing - Pulsus Paradoxus

10. Pneumothorax

11. Pleural effusion

12. Sinus bradycardia

13. Fast AF

14. Paced on ventricle

15. STs

16. Ectopics post inferior MI

17. Complete heart block