Behind the Night, the Surgery Podcast, relevant and engaging content designed to help you dominate the day.

Welcome back to Behind the Night. My name is Jess Camelar, PG-I-4 General Surgery resident at the University of Michigan.

I'm Aaron Williams, a second-year cardiothoracic surgery fellow with Duke, and I'm Nick Teaman, a cardiac surgeon at the University of Virginia.

And we are so excited to be the first cardiac surgery sub-specialty team for Behind the Night.

We know cardiac surgery can seem a bit daunting to some of our listeners out there, but both surgeons will come across cardiac surgery patients at some point during their training, whether in the OR, ICU, ED, etc.

And that's why we are excited to bring you episodes focused on high-yield topics to help you navigate common cardiac surgery challenges, discuss relevant literature to help you in practice, and to help our listeners feel more comfortable around cardiac surgery patients.

In this episode, we will discuss common cardiac surgery post-op problems. Whether you're on a cardiac surgery rotation or just covering an ICU with cardiac surgery patients for the night, these common problems are bound to occur.

Jessica, why don't you get us started with our first common post-op problem, leading?

Absolutely. So, let's imagine you have a 65-year-old female who's admitted to the cardiac ICU status post a three-vessel cabbage.

She was on cardiopulmonary bypass for a total of 120 minutes, and her ACT returned to baseline following protamine administration.

Her mediasinum appeared dry, prior to sternal closure, and she was four chest tubes, one in each portal space, and two in the mediasinum.

She rise to the ICU, intubated and sedated on a small amount of nor-epinephrine and dobutamine for hemodynamic support.

And her initial post-operative labs demonstrate a hemoglobin and hematocritz so much of her baseline and platelets of 80,000, all of her other labs were normal.

Approximately two hours after arriving to the ICU, though, you get paid by the bedside nurse,

who knows approximately 200 CCs out of one of the mediasinum chest tubes over the past hour.

So, pausing a second to talk about this scenario, cardiac surgery patients, especially, are at super high risk for post-operative bleeding.

Many of our patients are on anti-pletal or anti-crugulation therapy for concurrent comorbidities like coronary artery disease, cardiac sense in A-5,

and they experience extra-croporeal circulation injury due to the use of cardiopulmonary bypass and the high doses of anti-crugulation that we use during surgery while they're on bypass.

Additionally, there's other risk factors that could increase their risk of bleeding such as if this is an immersion operation, if it's a redo operation, how long they're on bypass, if we get other operations, etc.

So, Aaron, what are some of the common sites patients can bleed from post-cardiac surgery?

Yes, well, there's definitely a lot of these. It could be anything from the sternum, it could be any sort of cannulation site, it could be a proximal or distal anastomosis,

and really any branch off any of the grass, whether it's your mammary or vein, or even a radio for that matter.

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