Maryland CC Project Kim Boswell – POD 0: Care After Cardiac Surgery
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Aug 26, 2014 
Dr. Kim Boswell, an Emergency Medicine trained intensivist at the University of Maryland, dives into the intricate world of postoperative cardiac care. She discusses the critical early hours in the ICU following surgery and the evolution of open-heart techniques since the 1950s. The conversation also highlights key protocols required for monitoring patients post-surgery, addressing complications like hypothermia and arrhythmias. Additionally, Kim shares insights on fast-track recovery strategies, emphasizing rapid discharge through advanced surgical techniques and effective medication management.
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Essential Post-Op Monitoring
- Routinely use a Swan-Ganz catheter for precise hemodynamic monitoring in post-cardiac surgery ICU.
- Monitor heart rhythm, labs including H&H, platelets, electrolytes, and coagulation to guide management.
Manage Hypothermia Carefully
- Aggressively rewarm hypothermic cardiac surgery patients without overcorrecting to avoid vasodilation-induced hypotension.
- Maintain awareness of hypothermia's effects on coagulation, arrhythmia risk, and oxygen demand.
Post-Op Blood Pressure Management
- Target mean arterial pressure (MAP) of 70-80 mmHg postoperatively, modifying for special cases like aortic dissection.
- Avoid beta blockers early post-op; prefer nicardipine for hypertension, and use epinephrine for inotropic support.