Algorithms (eg PreOp Eval of the cardiac patient)

Question 1

Pre-Op Evaluation of Pacer/AICD

Answer 1

1. Indication for placement
2. Manufacturer
3. Pacer dependent rhythm?
4. Last time interrogated?
5. Affect of magnet placement
6. Reprogram pacer/disable anti-dysrhythmia if dual AICD/pacer

Question 2

Steps to wean from CPB

Answer 2

• Ensure normothermia
• Correct anemia, e- abnormalities, metabolic derangements
• Turn on ventilator alarms
• Recalibrate/zero transducers
• Check lung compliance and initiate ventilation
• Ensure heart is de-aired
• TEE to assess function/PA cath for numbers
• Midazolam to prevent awareness during rewarming

Question 3

Pre-Op Pheochromocytoma Optimization

Answer 3

• α-blockade for at least 7-10 days (phenoxybenzamine, phentolamine)
• BP < 165/90
• Restoration of intravascular volume
• Echo, ECG, CXR to evaluate cardiac function (dilated cardiomyopathy, ectopy, ischemia)
• B-blocker for rate control

Question 4

Steps to Wean from Cardiopulmonary Bypass

Answer 4

WRMVP (Wide Receiver Most Valuable Player)

1. Warm? (check bladder and PA temp)
2. Rhythm? (are they in NSR? Need to pace? Rate ok?)
3. Monitors ON
4. Ventilation (turn on the vent and gas)
5. Perfusion (what is the pump flow)

• Shoot SVR and CO, start inotropes/vasoconstrictors
• Give midazolam when fully off of bypass
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