54. Cardiac surgery Flashcards

1
Q

PA insertion absolute contraindications

A

Tricuspid / pulmonary stenosis
Right ventricle / atrium masses
Tetralogy of fallot

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2
Q

Most common cause for CNS complications after cardiac surgery

A

Embolism (micro gaseous emboli)

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3
Q

Heparin MoA

A

Antithrombin (factor III) activation

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4
Q

Action of nitroprusside

A

Expansion of veins and arteries

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5
Q

False high BIS in

A

Pacemaker
Hypothermia
Pump head rotation

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6
Q

Avoid hexakapron in

A

Upper urinary system bleeding

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7
Q

TEG. Problem and treatment
R K alpha Max amplitude Lysis

A

R - coagulation factors - Protamine / FFP
K - fibrinogen - cryo
alpha - fibrinogen - cryo
M.A Plt - Ptl +- DDAVP
Lysis. Excess fibrinolysis - HexaK

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8
Q

Hemodynamic goals in Bypass

A

Blood flow: 1.6 -3 l/min/m2
CVP 0
MAP 50-90
SVO2 65%

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9
Q

Chronic MR and Treatment

A

Increase afterload and HR
Decrease preload
Best Ephedrin

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10
Q

HIT treatment

A

Bivalirudin (angiomax)
If kidney failure argatroban

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11
Q

Hb goals in bypass

A

Minimum 6-7 before after bypass
6 during bypass

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12
Q

Levosimendan MoA and effects

A

Ca sensitizer
Increase HR x1, Contractility x2, Peripheral vasoconstriction x3

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13
Q

Systolic anterior motion treatment

A

SAM — Volume

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14
Q

Eccentric vs concentric rebuilding

A

Eccentric volume overload (Chronic AR)
Concentric pressure overload

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15
Q

Most sensible part of aorta during TEE

A

The distal part of the ascending

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16
Q

Decrease SvO2

A

In Decrease CO, Hb, Sat
No if changes in VO2

17
Q

Transcranial doppler

A

Measures the flow velocity of the middle cerebral artery

18
Q

BIS measures

A

Cortical function of the frontal area only

19
Q

Lysis of platelets and ACT

A

Shortens ACT

20
Q

Protamine dosage

A

0.8 mg to 100 IU of heparin
Max dose 2.6

21
Q

Protamine reactions

A

Type 1. decrease BP
Type 2. IgE. decrease in BP and brochospasm
Type 3. decrease BP + PHT

22
Q

Vasoplegic syndrome

A
23
Q

First line therapy for delirium after heart surgery

A

Haloperidol