BUMC Basics.pdf - Anesthesia Home

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Post PCI Complications — In your note following PCI, be
sure to comment on the following:
1. Vascular access site (check for hematoma)
2. Distal pulses
3. Any signs of cholesterol emboli syndrome (any livedo
pattern or toe necrosis)
4. H&H, Tele monitoring, Creatinine
5. Watch for the following complications:
• Hematoma/Bleeding: Manual compression,
reverse/stop anticoagulation
• Retroperitoneal bleed (hypotension,
abdominal/flank pain, dropping H&H): Stat CT
abd/pelvis if concern for retroperitoneal bleed and
stable enough to go. Blood, fluid, and pressors,
and call cardiologist immediately. May need
vascular consult.
• Pseudoanerysm: triad of pain, expansile mass,
systolic bruit; Dx with U/S; treat with compression
or surgical repair
• Contrast induced Acute Kidney Injury:
Manifests within 24 hours; peaks at 3-5 days;
Pre-hydrate patients to prevent kidney injury with
IV fluids. Continue IVF’s after cath to protect
kidneys
• Cholesterol emboli syndrome: Renal failure,
eos in urine, mesenteric ischemia, toe necrosis,
Hollenhorst plaques in retinal arteries
• Stent thrombosis: Urgent return to cath lab
• In-stent restenosis (months after PCI)
Prognosis
Killip Class (on admission):
Class Signs Mortality
I No CHF 5%
II S3, and/or crackles of lung
exam
17%
III Pulmonary edema 30-40%
IV Cardiogenic shock 60-80%