[HSF] Cardiac arrest after redo CABG in a young patient

[Donald Ross]

Bob,
How do you measure pericardial pressure?
Don
On 06/12/2007, at 12:22 AM, Rwmfglycar at aol.com wrote:

>
> Yes, opening a chest with retracted clot around the heart demands  
> great
> skill and delicacy not to do great damage. However opening the  
> lower end of the
> incision and releasing the fluid part of postoperative tamponade  
> was something
> our PA's and resident's were trained and obliged to do. You mention  
> what
> happens  to pressuresin :  tamponade is the consequence of  
> pericardial pressures
> rising above  the diastolic
> pressures of the ventricle/s. If we were in a situation where we  
> were  trying
> to differentiate between particularly right heart failure and  
> tamponade  we
> would quickly measure a pericardial pressure. With right heart  
> failure and no
> tamponade the CVP is higher than the pericardial pressure. With  
> tamponade  the
>  pericardial pressure is equal to the  CVP/LAP.
> .  Frater  RWM: Pericardial Tamponade and Intrapericardial
> Pressures.  Ann Thorac Surg  1970;10:563-565.
> I don't like rules such as:  Never open  the chest in the ICU and  
> Always open
> the chest in the ICU. However there was one  rule about cardiac  
> massage: if
> your hand is big enough open  cardiac compression  is done with  
> four fingers
> touching each  other side by side behind the heart and the thenar  
> eminence in
> front. The  thumb is dorsiflexed. If your hands are too small then  
> massage is
> done two  handed. The result is always confirmed by evidence of a  
> good arterial
> pressure  and pulse.
> Bob
>
>
> I  would beg to differ - while many of you who have been around the  
> block a
> few  times may be quick to open the chest. We were always trained  
> that unless
> clear  tamponade, opening a chest emergently usually leads to more  
> trouble - in
> the  midst of chaos, grafts (esp IMAs) get pulled off, manual CPR  
> results in
> RV  thumb holes, critical pacing wire get torn. My question to the  
> group is,
> in my  limited experience tamponade comes up quickly but not  
> instantly - the
> tubes  slow down, or even stop, the PA pressures go up, CVP goes  
> up, systemic
> pressures go down, increasing drips doesnt work, unless a true  
> disaster - like
> a hole in the aorta or similar, usually there is sometime. While  
> the comments
>  about how no open heart patient should die without having their  
> chest open
> has  some merit, it should not be the first intervention, not in my  
> opinion be
> performed lightly without the input of the attending (or very senior)
> surgeon.?
> ?
> We have lost a few very obese patients and I suspect PEs (or  mucus  
> plugging
> from poor pulm mechanics) - which may be in this case. Very  obese,  
> dont move
> around much, these patients are often chronically dry,  etc.?
> ?
> -michael?
>
>
>
>
>
>
>
> **************************************Check out AOL's list of  
> 2007's hottest
> products.
> (http://money.aol.com/special/hot-products-2007? 
> NCID=aoltop00030000000001)
> _______________________________________________
> OpenHeart-L mailing list
>
> Send postings to:
>  OpenHeart-L at lists.hsforum.com
>
> To UNSUBSCRIBE, to CHANGE email address, or to view archives:
> http://mmp.cjp.com/mailman/listinfo/openheart-l
>
> All messages transmitted by the OpenHeart-L are subject to the  
> policies and
> disclaimers posted at:
> http://www.hsforum.com/listdisclaim
> -----------------------------------------