Discuss the steps taken for the management of Mrs Murphy's deterioration with increased drainage from the drain tube post cardiac surgery.
Discuss the steps taken for the management of Mrs Murphy's deterioration with increased drainage from the drain tube post cardiac surgery
Suggested response: Assess haemodynamic state and end-organ function with a view to re-establishing haemodynamic stability, optimising cardiovascular performance and preventing end-organ dysfunction/failure. For cardiac tamponade, cardiac output must be optimised with fluids to replace circulating volume (filling pressures will be raised reflecting increased pressure, not fluid status) and inotropes to augment contractility to achieve a MAP >70 mmHg and cardiac index >2.2 L/min/m2. Provide full respiratory support and monitor conscious state and urine output for signs of therapeutic effect. Perform interventions to correct the causes of blood loss including replacement of coagulation factors, reversal of anticoagulation (e.g. heparin) and surgical repair.
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