Background/IntroductionLiterature suggests 25-50% of patients develop arrhythmia following cardiac surgery.Within a regional cardiothoracic centre in Scotland, guidelines exist on initial management of post-operative atrial arrhythmia.However, in practice various approaches are used.Arrhythmias contribute to prolonged hospital stay and high dependency readmission. Aims/ObjectivesTo assess staff awareness of local guidelines, audit the proportion of patients developing arrhythmia and check for correlation with logistic EuroScore and length of hospital stay.Approach to management of arrhythmia within the initial 48 hours following identification was compared to local guidelines.
Abstract This chapter describes the role of the cardiac intensive care unit (CICU) in the management of adult patients with congenital heart disease (ACHD). This is a growing population as possibly 90% of infants with congenital heart disease now survive to adulthood. Patients with ACHD may present to CICU in three circumstances: postoperatively following cardiac intervention, postoperatively following non-cardiac surgery, and during the management of a medical emergency. Specialist expertise on the physiological consequences of the abnormal cardiac anatomy can optimize the CICU outcome. The chapter presents a glossary and description of common congenital syndromes and descriptors. It goes on to consider management of key problems including arrhythmias, cyanosis, haemoptysis, and heart failure. It outlines the general principles of care in patients with ACHD and discusses the implications of some important specific conditions: tetralogy of Fallot, transposition of the great arteries, and the Fontan circulation.
dominated MLSOs should never again be able to feel that they have achieved a monopoly of the out-of-hours duty rosters operated by this laboratory, and I trust that other heads of laboratories will share this view.
The chapter describes the normal recovery process after cardiac surgery. This is generally uneventful; however, a small proportion of routine patients develop an important treatable complication. A second small group of patients are critically ill and dependant on exact optimization of their physiology, either because of their preoperative condition or their operative course or both. The latter group are usually obvious and are often already on substantial support and invasive monitoring when they leave theatre. Recognizing the first group is crucial and is a key skill of cardiac intensive care. The key to success with these patients is early proactive management. In turn, this requires attention to detail, an understanding of normal postoperative course, close serial observation, and excellent diagnosis employing early use of additional monitoring and investigation
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