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Special Cases (Boards) > Blue Book > Flashcards

Blue Book Flashcards

1
Q

aneurysm definition

A

expansion of the wall of a blood vessel

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2
Q

what is an aneurysm caused by

A 
atherosclerosis: build up of plaque on the inside of an artery
hypertension
injury
infection
marfan's syndrome
pregnancy
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3
Q

aneurysms of the aorta may rupture immediately causing what?

A

loss of systemic blood flow volume and pressure

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4
Q

dissection definition

A

tear in the layers of the aortic wall causing blood to flow between the layers of the aorta

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5
Q

how is arterial blood pressure ideally monitored in an aortic arch repair

A

left radial art line and femoral line

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6
Q

why is the left radial used and not the right?

A

the right may be compromised by the clamping on the ascending aorta since the right radial arises from vessels off the innominate arty which is often too close to affected area

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7
Q

when there is a dissecting thoracic aortic, what may become obstructed coming off the aorta?

A

cerebral, coronary, renal and peripheral vessels

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8
Q

what will you see if there is a dissection during cardiac surgery?

A

the arterial perfusion line pressure may rise immediately and then possibly fall as the dissection extends

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9
Q

describe debakey’s classification of thoracic aortic dissections

A

Type 1: begins in the ascending aorta just above the aortic valve and extends into the descending aorta

type 2: includes the ascending aorta only

type 3: originates distal to the left subclavian artery and involves the descending aorta only

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10
Q

what the device that is used to monitor the oxygen saturation in both sides of the brain?

A

cerebral oximeter

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11
Q

what can the cerebral oximeter help the perfusionist measure?

A

indirect assessment of the cerebral blood flow

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12
Q

what are some “cons” of the clamp and go method for descending thoracic and thoracoabdominal aneurysms?

A
  • kidneys, liver, and gastrointestinal regions are not perfused
  • left ventricle must eject against a clamped aorta, which can increase after load of the left ventricle (blood left in the ventricle after ejection)
  • anterior spinal artery syndrome
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13
Q

Temperatures of _____ degrees C and below are thought to cause cessation of the brain’s electrical activity and provide optimal protection

A

15 degrees C

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14
Q

Some research shows that hyperglycemia in circulatory arrest patients may cause damage to the central nervous system. Therefore, what should be give to the patient?

A

Insulin should be given if blood glucose levels rise too high prior to circulatory arrest

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15
Q

what other drugs are given to patients undergoing circulatory arrest?

A

sodium Pentothal: causes the brain’s electrical activity to decrease

forane: barbiturate effect on the brain (sedative or sleep-inducing drug)

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16
Q

A temperature gradient less than __ should be maintained during rewarming. Why?

A

less than 8 degrees.

More oxygen is held in solution in cold blood, and warming the patient to rapidly may cause micro bubbles

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17
Q

mild temperature

A

32-37

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18
Q

moderate temperature

A

28-31

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19
Q

deep temperature

A

18-28

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20
Q

profound temperature

A

0-18

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21
Q

if the patient is 32 degrees C, what should the arrest period be?

A

under 10 min

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22
Q

if the patient is 28 degrees C, what should the arrest period be?

A

10-15 min

23
Q

if the patient is 18 degrees C, what should the arrest period be?

A

16-45 min

24
Q

if the patient is under 18 degrees C, what should the arrest period be?

A

46-60 min

25
Q

what is a pulmonary embolism and what can it cause?

A

embolism may be a blood clot, fat, air or debris

result in circulation to a lung being stopped or compromised

26
Q

in patients who are rapidly deteriorating from pulmonary embolism, what surgery might be done?

A

pulmonary embolectomy

27
Q

what are indicators that a patient may need emergency surgery to remove embolus?

A
  • arterial pO2 less than 60 mmHg
  • systolic blood pressure less than 90 mm Hg
  • urine output less than 20 cc an hour
28
Q

what are the most common problems that occur during pregnancy?

A

valvular disorders

29
Q

when is the safest period for the mother and the fetus for the surgery to be performed?

A

second trimester

30
Q

why is the first trimester dangerous for surgery?

A

the embryo is easily injured by hypoxemia, drugs, and other factors

31
Q

why is the last trimester dangerous for surgery?

A

premature labor can occur

also, the blood volume of the fetus and the output directed to the uterus is at its greatest

32
Q

does heparin cross the the placental barrier?

A

NO

heparin does not cross the placenta

33
Q

what anticoagulant does?

A

Coumadin

34
Q

if a mitral valve is necessary, what valve must be used on the pregnant patient?

A

porcine valves that do not require anticoagulants

35
Q

why are pregnant patients not cooled?

A

because the fetal heart rate would decrease and uterine contractions may be precipitated by rewarming

36
Q

what is the BPM that the fetus must stay in range of when on bypasss?

A

60 BPM

37
Q

what are the flows on a pregnant patient?

A
  • flows are maintained high

- cardiac index of 3 to 3.2 L/min/M sq may be necessary to ensure the fetal heart beat is kept above 60 BPM

38
Q

what should the mother’s blood pressure be kept at to provide optimal flow to the uterus?

A

65 mmHg

39
Q

what should be used to increase the pressure while on bypass for a pregnant patient?

A

epinephrine

40
Q

what drugs should not be used on bypass? and why?

A

neosynephrine and levarterenol

these drugs are alpha agonists and can compromise blood flow to the uterus

41
Q

what drug should be used for hypertension on a pregnant patient?

A

hydralazine

42
Q

what drug should NOT be used for hypertension on a pregnant patient? and why?

A

sodium nitroprusside

cyanide toxicity possible and its effect of the fetus

43
Q

what are cold agglutinins or cryoproteins?

A

antibodies that work on the antigens found on the surface of red blood cells that cause complement activation and red blood cells to clump at low temperatures and break down

44
Q

what antibody class are usually the one where the agglutination is significant?

A

IgM

45
Q

if a patient must be cooled to temperatures that may cause a reaction, what is necessary?

A

plasmapheresis

46
Q

if cold cardioplegia is desired for a cold agglutinins patients, what type should be used?

A

plain crystalloid

47
Q

what is cannulation for a hypothermia patient?

A

femoral artery and femoral vein

48
Q

what should the setup of the circuit be for hypothermia patients?

A
  • half of heparin should be circulated in the pump prime if the ability of the patient to circulate the heparin is in question
  • ultrafiltrator is used to control volume status and because of the possibility of ensuing renal failure
  • oxygenator will help the patient if they may be in an acidotic state
  • temperature of the priming solution should be near the patient’s core temperature when bypass is initiated
49
Q

how fast should hypothermia patients be warmed?

A

rewarmed at a rate of 4 degrees an hour to ensure adequate recovery time and uniform rewarming

50
Q

what should be done when a hypothermia patient starts fibrillating during rewarming?

A

cardioversion should be attempted when the core temperature has reached 32 C

51
Q

what is the goal when performing CPB on Jehovah’s Witness patient?

A

strict blood conservation

autotransfusion, ultrafiltration, and return of the chest tube output

52
Q

what should be taken into consideration when setting up a pump for Jehovah’s Witness patient?

A
  • minimizing the pump circuit and priming volume
  • blood is returned to patient in a continuous loop by connecting cell save or chest tube directly in line to an IV site for direct infusion
53
Q

what drugs can be given to manage blood?

A

hespan or dextran may be given as plasma expanders

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