Question 13.1 from the first paper of 2009 asks the candidate to come up with reasons for why their post-op CABG patient is bleeding to death, and to come up with a management strategy. Something similar occurs in Question 13 from the first paper of 2012 and Question 2 from the first paper of 2021. In addition to this, all those frequently repeated SAQs about the management of the haemodynamically unstable cardiac patient all involve the discussion of bleeding at some stage.
Sadly, bleeding complications are common enough to merit their own chapter. Excessive bleeding is usually due to one or more of the following factors:
So, your patient is bleeding into their pericardium. Why is the patient bleeding? There are two main categories for this; lets say one category is the surgeon's fault, and the other is the anaesthetist's fault.
Surgical causes of post-bypass haemorrhage
Medical causes of post-bypass haemorrhage:
One can safely say that in the ICU, apart from waking up the surgeons, nothing can be done about the first category. However, we can make moves on the medical causes.
A normothermic patient with normal coagulation parameters should not be bleeding post-operatively if the surgical tasks have been completed to a satisfactory standard. Ergo, having gone through the abovelisted steps, one can ring the surgeon and ask them to get back into the chest. For them, an arterial bleed from a coronary artery graft is an easily reversible cause of haemodynamic collapse.