Bleeding Post Cardiac Surgery

Published 03/08/2022

Bleeding Post Cardiac Surgery

Set-up:

 

Lines/access:

RIJ CVC, left radial arterial line, 2 large bore peripheral cannulae

Infusions:

Sedatives, sodium nitroprusside & 1L crystalloid (attached but not running)

Airway:

ETT

Ventilator:

VCV 500/8 FiO2 0.5Rate 10 breaths/min

Other:

Drains able to fill with blood – see video

Blood products

Mannequin must have 2 ID bracelets (blood product checking)

Clinical Setting

I:    You are the CICU registrar and are asked to prescribe a fluid bolus for a post-            surgical patient

S:   Nurse reports that night doctor forgot to prescribe more than one bolus, and the        patient is a little tachycardic but requiring sodium nitroprusside to achieve systolic blood pressure targets

B:   70F immediately post CABG+AVR

A: Mildly tachycardic requiring colloid therapy

R: Asked to chart fluids

Potential Clinical Course

  • Initially A ETT, B SpO2 99% on FiO2 0.5, VCV 500mls @ 10breaths/min, PEEP 7, ETCO2 4.6kPa, reduced breath sounds both bases C HR 98bpm, BP 101/72, D Sedated
  • Becomes more tachycardic despite fluid bolus
  • Quick dump of 300mls into drain then stops
  • BP falls – discontinue sodium nitroprusside
  • Further dump of 600mls into the drain
  • Candidate declares major haemorrhage – manages blood products and resuscitation
  1. Red Cells
  2. FFP
  3. Platelets
  4. Cryoprecipitate
  5. Protamine
  6. TXA
  7. Calcium
  8. Warm
  • Calls for senior help and cardiac-surgical help
  • Begins to package patient for return to theatre
  • Discusses further blood product management with lab – requests further products appropriately
  • Anaesthetist arrives to take patient back to theatre – give clear and succinct handover
Bleeding Post Cardiac Surgery
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