The other night I had my first post-op open-heart surgery patient...and just my luck he's on an Intra-Aortic Balloon Pump. He had poor left ventricular function. The IABP basically rests his heart and augments pumping by inflating when the ventricle relaxes to allow more blood in then quickly deflating right before the ventricle closes to increase pressure to push blood out. This decreases the SVR (afterload) and increases Coronary Artery perfusion to perfuse the myocardium. Ha. I THINK I got that right.

So the night I have this guy I'm orienting to the IABP...thank goodness I wasn't on my own. His pressures were labile, SBP 80-90s, MAPS 65-70. He was on 4 pressors: Dopamine, Phenylephrine, Epi, and Vasopressin. LOVE IT. Plus he has a HUGE drug history, so he was on high amounts of Fentanyl & Versed. The usually stern & scary Cardiothoracic Surgery Attending was unusually pleasant and humorous.

See his tattoos? Count how many he has, multiply that number by 10 and THAT is how much Fentanyl he should be on. I definitely was less nervous after that encounter...usually I want to pee my pants when I see him walking my way. HA.

Orienting for 12 hours went okay. Then I get the "Ok. You're going to have him all by yourself when you come back tonight. Good luck."

Okay.

So that was last night. Thank goodness he was a little bit more stable. Neo, Dopa, & Vasopressin were titrated down. By the end of my shift I was able to wean Neo to off and Vasopressin to a very miniscule dose. I even weaned his sedation to minimal doses without this guy freaking out on me.

I feel like a big grown up ICU nurse now that I'm able to take the post-op hearts on my own. Yay me. =)