SurgSpace / Specialties / Cardiac Surgery
Cardiac Surgery
The heart and great vessels: bypass grafting built on the coronary map, valve repair and replacement stitched millimetres from the conduction system, and the physiology of cardiopulmonary bypass, the machine that lends the patient a heart and lungs for an hour.
Backdrop: A cardiac surgery operating room · Pfree2014 · CC BY-SA 4.0
After, and when it goes wrong
Post-op & Emergencies
The expected course, the ward reads, and the calls that cannot wait.
The expected course and the ward reads, then the complications and the calls that cannot wait.
On the ward
Three boards, three reads
POD 1 · CABG
HR 108
BP 104/65
Chest tube 80 mL/hr
Urine 30 mL/hr
Hb 89
What matters most on this board?
The read
The drain and the haemoglobin, read together: 80 mL/hr is watchable but trending matters, and an Hb of 89 says some of the tachycardia is volume. The urine output is the ventricle and the volume speaking; recheck after filling before blaming the kidneys.
POD 2 · rising support
Noradrenaline climbing
Urine output falling
Lactate 3.8 and rising
Which way does this go?
The read
This is not a fluids-and-review board: rising pressors with rising lactate after cardiac surgery is tamponade or low cardiac output until proven otherwise, and the proof involves an echo and a surgeon, quickly.
POD 2-3 · new atrial fibrillation
HR 145, irregular
BP holding
Patient feels flutters
Emergency or expected?
The read
Post-operative AF is the commonest arrhythmia after cardiac surgery, typically POD 2-3. Stable means rate control, correct the potassium and magnesium, and reassess; unstable means cardioversion. Expected does not mean ignorable: it earns anticoagulation conversations if it stays.
Emergencies
The calls that cannot wait
Type A aortic dissection
Recognise: Tearing pain, pulse deficits, widened mediastinum; CT confirms the ascending aorta is involved.
First move: Control pressure and pulse while theatre and perfusion are mobilised: the operation is the treatment.
Post-operative tamponade
Recognise: Rising filling pressures, falling output, quiet drains after cardiac surgery: Beck's triad wearing a fresh sternotomy.
First move: Reopening is the treatment; the ICU's job is recognition and the call, not another hour of watching.
Massive post-operative bleeding
Recognise: Drain output by the hundred millilitres per hour, a falling haemoglobin, and a coagulation screen bent by bypass.
First move: Correct the coagulopathy while deciding early whether this is surgical bleeding that needs the OR again.
Cardiogenic shock
Recognise: Cold, wet and hypotensive with a heart that cannot keep up: post-infarct, post-cardiotomy, or the end of a valve's compensation.
First move: Support the circulation while finding the surgical lesion, if there is one: mechanical support is a bridge, not a destination.
Hub shaped by the Surgical Specialties Lead with the Cardiac surgery reviewer (open seat). Images and videos carry their source; educational use for supervised learning, not clinical guidance.