Case Study #4

82 year old male patient admitted to Cardiac Unit post-emergent 4 vessel CABG. Chest tube output was 300ml in PACU. First hour on unit, chest tube output is another 200ml. Second hour on unit, chest tube output is 30ml.

Vital Signs 1st Hour:

CVP = 7

ABP = 102/56

HR = 88

RR = 14

Urine output = 80ml

 

Vital Signs 2nd Hour:

CVP = 15

ABP = 92/76

HR = 125

RR = 18

Urine output = 10ml

Next Hour

The patient's BP continues to decline and  you have given 500ml 5% albumin. The vital signs are slightly better, but your inner voice says things are not quite right.

BP  = 100/78

HR = 120

CVP  = 18

Urine Output  = 10ml

Chest tube output = 0

Correlate Your Assessments

• Low BP, narrowed pulse pressure

• Arterial & SaO2 waveform: pulsus paradoxus?

• Increased CVP

• Increased JVD

• Decreased urine output

• Decreased to ZERO chest tube output

So, what is the problem?

Cardiac Tamponade

• Your patient is compromised: act quickly!

• Elevate head of bed

• Notify MD

• Fluids!

• Prepare for procedure:

• back to OR to locate source of bleeding

• pericardial window or pericardiocentesis

 

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