Because of the lesion's location and the physician's inability to pass a guide wire through it, no interventional procedure can be done at this time. The cardiothoracic team is called to perform emergency bypass surgery. The cardiologist inserts an IABP to decrease afterload and increase myocardial perfusion. Mr. Tan is diaphoretic and has weak pulses. Decreased renal perfusion leads to oliguria, and decreased cerebral perfusion causes mental status changes, including confusion, disorientation, and agitation.
Some patients also develop metabolic acidosis and cardiac arrhythmias.
A PA catheter and arterial line are inserted, and Mr. Tan is transferred to the coronary care unit for further monitoring and treatment until the cardiothoracic team arrives. Monitor him closely for changes in status. Treat pain and anxiety with opioids and sedatives, but cautiously and with consideration of his BP and oxygenation status. You'll use the hemodynamic values to guide fluid administration. If fluid overload occurs, give diuretics with caution to prevent hypotension.