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Cardiopulmonary Bypass Notes (Boards) > 2020 Review > Flashcards

2020 Review Flashcards

1
Q

If there is a decrease in SvO2, what should you do?

A

increase flows

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2
Q

Why does blood pressure decrease when the clamp comes off?

A

lung ventilation

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3
Q

When is the best time for plasmapheresis?

A

After anesthesia and before they cut into patient

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4
Q

What is plasmapheresis?

A

a device separates whole blood into the cellular compartments and plasma. The plasma is then discarded and replaced with colloid fluid, combined back with the cellular components and returned to the same patient

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5
Q

what is the ideal post dilution hematocrit on bypass

A

23-35

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6
Q

with no heparinization, what should be the lowest flow rate?

A

1 LPM.

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7
Q

what is perfusion pressure

A

pressure of oxygen to tissues

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8
Q

what is the ideal place for O2 analyzer?

A

after the gas line

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9
Q

what can lead to an increase in glucose and hyperkalemia on pump

A

decrease in insulin

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10
Q

when is serum glucose the highest?

A

during rewarming

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11
Q

hyperkalemia definition

A

a potassium level in your blood that’s higher than normal

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12
Q

what should you do if you have a runaway pump?

A

clamp arterial line

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13
Q

if there is gas flow interference when you are on pump and there is no O2 tank available, what should you do?

A

put the O2 line in the roller head

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14
Q

what is the best indicator of adequacy of perfusion

A

SvO2

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15
Q

what is hemoglobinuria and what does it show a perfusionist?

A

excretion of free hemoglobin in the urine and is a CPB trauma

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16
Q

when scrubbing into surgery, how long should you scrub your hands for?

A

2-5 minutes

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17
Q

a contraindication for cell salvage is

A

use of micro fibrillar collagen hemostat

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18
Q

antibiotics aspirated in cell salvage cause what?

A

hemolysis

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19
Q

what is the ratio of cell salvage

A

7 parts citrate to 1 part blood

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20
Q

if you given back a significant amount of cell saver and the PTT and PT are still not correct, what should be given?

A

FFP

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21
Q

PRBCs with citrate can be stored for how long?

A

35 days

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22
Q

for an air embolism, what should be done immediately

A

put the patient in trendelenburg position

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23
Q

what is normal NIRS range?

A

75-80

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24
Q

what does NIRS measure?

A

cerebral oximetry

local SaO2 and SvO2

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25
Q

what does NIRS consist of?

A

four diodes per pad

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26
Q

what does BIS monitoring tell us?

A

indication of depth of anesthesia

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27
Q

90-100 BIS tells us

A

patient is awake

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28
Q

60-90 BIS tells us

A

light to moderate mediation

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29
Q

40-60 BIS tells us

A

goal sedation during surgery

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30
Q

20-40 BIS tells us

A

brain suppression

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31
Q

0 BIS tells us

A

electrical silence meaning absence of brain activity

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32
Q

what is the use for TEE during cardiac surgery?

A

to check for air

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33
Q

what does EEG stand for?

A

electroencephalogram

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34
Q

what does an EEG tell us?

A

a test used to find problems related to electrical activity of the brain. usually used to check for adequate brain perfusion

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35
Q

what is the risk of giving a lot of bank blood?

A
  • citrate toxicity
  • hypotension
  • decreased pulse pressure
  • increased LVEDP and CVP
  • arrhythmias
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36
Q

what does temporary epicardial pacing consist of?

A

pacing wires sutured to the epicardium of the heart, on the atrium, and on the ventricle

37
Q

without myocardial protection, irreversible damage begins to occur after how long?

A

20 minutes

38
Q

in a patient with DMII, upon initiation of CPB, what happens?

A

causes a dilution effect that stimulates alpha cells in the islets of Langerhans which will cause glucagon release and will cause glucose in the blood to rise

39
Q

reperfusion injuries occur when?

A

when the cross clamp is removed

40
Q

what causes reperfusion injuries?

A

air

41
Q

what is reperfusion injury?

A

myocardial, vascular, or electrophysiological dysfunction after blood supply returns to once ischemic tissue

42
Q

what are symptoms of reperfusion injury?

A

inflammation (neutrophil accumulation), oxidative damage, arrhythmias, and endothelial cell damage

43
Q

five mediators of reperfusion injury

A
  • Ca influx
  • neutrophils
  • compliment activation
  • O2 free radicals
  • edema
44
Q

what do neutrophils do in reperfusion injury?

A

they release oxygen free radical scavengers

45
Q

what else does neutrophils also produce that might help reperfusion injury?

A

superoxide

superoxide dismutase is an enzyme that helps break down potentially harmful oxygen molecules in cells, which might prevent damage to tissues

46
Q

how are neutrophils affected by reperfusion?

A

they are chemotactically altered by reperfusion from the release of protease

this can cause endothelial stiffness, which decreases the flexibility needed for capillary flow, promotes microembolization and is implicated in post-ischemic edema

47
Q

during reperfusion injury, what do oxygen free radicals produce?

A

peroxide, which causes damage to the cells

48
Q

how do oxygen free radical scavengers work?

A

they work in the body by converting hydrogen peroxide to water and CO2

49
Q

respiratory acidosis values

A

pH is <7.35
CO2 is > 45
HCO3- is normal
BE is negative

50
Q

respiratory alkalosis values

A

pH is >7.45
pCO2 is <35
HCO3- is normal
BE is positive

51
Q

compensated respiratory acidosis has what values

A

normal ph
high pCO2
high HCO3-

52
Q

compensated respiratory alkalosis has what values

A

normal pH
low PCO2
low HCO3-

53
Q

what do you do to correct metabolic acidosis

A

give bicarb

54
Q

what will be seen with uncompensated respiratory acidosis

A

low pH
high CO2
normal bicarb

55
Q

what can metabolic alkalosis be treated with

A

lactated ringers
ammonium chloride
diamox

56
Q

what is the main drop in blood pressure after initiation of bypass?

A

hemodiluution of catecholamines causes hypotension upon initiation

57
Q

what is the partial pressure of O2 at 760 torr?

A

160

58
Q

increasing the peep will ___ O2

A

increasing the peep will decrease O2

59
Q

at a given pO2, increasing the pCO2 results in what?

A

less oxygen bound to hemoglobin

60
Q

what could be the cause if the heart start beating during a redo CABG after cross clamp is on

A

the hear has been rewarmed from patent mammary

61
Q

increased pressure in the hemoconcentrator can be due to

A

decrease in temperature

62
Q

to increase the partial pressure of O2 in the oxygenator, what can be done on pump?

A

increase FiO2

63
Q

what are heparin coated oxygenators?

A

polymethylpentene and polypropylene

64
Q

what are the advantages of polymethylpente oxygenators? (PMP)

A
  • low transmembrane pressure drop
  • can be heparin coated
  • will not “wet out”
65
Q

what is membrane shunting?

A

when blood passes through the oxygenator without being oxygenated

66
Q

what is the most common complication of KVAD?

A

reversal of flow and entrapment of air

67
Q

max vacuum setting for VAVD

A

-90 mmHg

68
Q

the average negative gravity pressure in the venous line from patient to reservoir is

A

-15 to -30 mmHg

69
Q

what is the cause of most hemolysis from suckers

A

blood to gas interface

70
Q

the longer the tubing is the ___ the pressure drop

A

the longer the tubing is, the greater the pressure drop

71
Q

pressure drop is in direct proportion to what

A

tubing length

72
Q

PVC tubing in roller heads will start deteriorating in what direction

A

by cracking and breaking from outer edge in

73
Q

what are the differences between the different types of flow probes?

A

electromagnetic: direct blood contact, electro chemical contact with sensors
ultrasonic: no contact with blood, uses waves to calculate flow
doppler: acoustics to measure blood flow

74
Q

what are positive displacement pumps also known as

A

occlusive roller head

75
Q

characteristics of positive displacement pumps

A
  • preload dependent
  • afterload independent
  • high negative inlet pressure
  • high positive outlet pressures
  • occlusive
76
Q

characteristics of an under occluded roller pump

A
  • inaccurate flow measurements
  • backflow
  • excessive turbulence
77
Q

if the inflow to a roller pump is occluded, what will happen

A

cavitation with occur

78
Q

centrifugal pumps are ____ dependent and use ____ to move fluid

A

after load dependent and use kinetic energy to move fluid

79
Q

what is the most common mechanical complication associated with centrifugal heads

A

magnetic decoupling

80
Q

micro emboli from the reservoir is from

A

vortexing

81
Q

the heat transfer in heat exchanger occurs due to

A

forced convection and conduction

82
Q

what is the prebypass filter made of

A

polyurethane

83
Q

what is the size of the prebypass filter

A

.2-5 microns

84
Q

the best material for a filter is

A

polyester

85
Q

screen filters are by ___ size

A

pore size

86
Q

size of a gas filter

A

.2 microns

87
Q

size of a leukocyte depleting filter

A

.2 microns

88
Q

size of a cardiotomy filter

A

20-40 microns

89
Q

size of a pall filter

A

40 microns

Cardiopulmonary Bypass Notes (Boards) (3 decks)

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