Abnormal patient progression

Common things are common. Establish the underlying pathophysiology causing the anomly - identify the syndrome and then find the cause. The heart is the most common problem post cardiac surgery and most cases of non-progression are cardiac in origin. Pattern recognition is of vital importance in diagnosing major morbidity and its cause

Cardiac problems

	Features
Hypovolaemia / Empty	Peripherally cool Tachycardia Low filling pressures Diminished end organ function (reduced urine output) Altered metabolic state (increased lactate) Hypotension may occur late
Ventricular failure	Failure to peripherally warm Rhythm problems Alterations in filling pressures Diminished end-organ function (reduced urine output) Altered metabolic state (increased lactate) Hypotension may not occur
Tamponade	Peripherally cool Tachycardia Raised filling pressures Diminished end-organ function Altered metabolic state (increased lactate) HYPOTENSION
High output	Peripherally warm Often no rhythm problems

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Abnormal patient progression