Consider Cardiac Tamponade
Refractory hypotension with hypoperfusion (cold extremities, poor urine output, increasing metabolic acidosis) and poor response to fluid challenges and inotropes.
A sudden reduction in drainage from chest drains
Increased filling pressures (CVP and PA pressures)
Increased cardiac silhouette.
Consider Valsalva during awakening
See sedation page.
Consider Acute Focal Myocardial Ischaemia with ECG changes
Notify Intensive Care specialist and surgeon.
Consider Low Cardiac Output State
Persistent hypotension with hypoperfusion (cold extremities, poor urine output, increasing metabolic acidosis) unresponsive to fluid challenges.
If assessed as having a low cardiac output state clinically or from direct measurement (PA catheter of PICCO),consider starting dopamine, adrenaline or Dobutamine combined with Noradrenaline or Phenylephrine.