CABG 2 Flashcards
WHAT POSITION SHOULD THE PATIENT BE IN TO FLOAT A SWAN?
REVERSE TRENDELENBERG WITH LEFT ROATION.
WHAT BLOOD PRODUCTS SHOULD BE AVAILABLE FOR A CABG?
2-4 UNITS PRBC ORDERED AND AVAILABLE. IF THE PT IS ON PLAVIX OR BLOOD THINNERS THEN 10 UNITS OF PLT WILL BE ORDERED.
IF THE CABG IS A REDO THEN BLOOD MUST BE IN THE ROOM FOR STERNOTOMY!!!
WHAT IS USED TO DETERMINE FLOW RATES FOR PERFUSION?
BSA….BODY SURFACE AREA.
WHAT IS THE CARDIAC INDEX GOAL DURING THE REWARMING PERIOD?
2.4
WHAT ARE THE PARAMETERS FOR POOR LEFT VENT FUNCTION AND HOW DOES THIS AFFECT YOUR INDUCTION?
POOR=MULTIPLE MI’S, SYMPTOMATIC CHF, EF < .40, LVEDP>18, DECREASED CO.
PROCEED WITH LIGHT PREOP SEDATION. HIGH NARCOTIC TECHNIQUE…PROBABLY WONT BE FAST TRACKED. ETOMIDATE.
WHAT ARE THE 4 MAIN THINGS TEE IS LOOKING FOR POST INDUCTION?
VENTRICULAR ABNORMALITIES, CHAMBER DIMENTIONS, VALVULAR ABNORMALITIES, INTRACARDIAC AIR.
WHAT DRUGS ARE GIVEN PRIOR TO STERNOTOMY?
MAG SULFATE 2GM TO PREVENT VENTRICULAR ARRYTHMIAS.
AMICAR 5GM TO PREVENT FIBRINOLYSIS. (YOU WILL GIVE ANOTHER 5GM POST PROTAMINE)
WHAT WILL YOU BE PREPARED TO TREAT POST INDUCTION?
HYPOTENSION! LOW STIMULATION. SNS IS BLUNTED. USE THAT STICK OF NEO BITCH!
WHAT IS ACT, WHEN SHOULD IT BE DRAWN, AND WHAT ARE NORMAL AND DESIRED LEVELS ?
ACTIVATED CLOTTING TIME MEASURES INTRINSIC (HEPARIN) PATHWAY. LOOKS AT TIME FOR CLOT TO OCCUR. FIRST DRAW POST INDUCTION PRIOR TO AMICAR ADMINISTRATION TO ESTABLISH BASELINE THEN POST HEPARIN AND PERIODICALLY THROUGHOUT. NORM= 80-120. WANT IT 480 POST HEPAIN.
WHAT IS THE ONLY DRUG THAT MUST BE GIVEN PRIOR TO CPB?
HEPARIN. DOSE: .3CC/KG (300UNITS/KG) HAVE IT READY IN CASE YOU HAVE TO CRASH ON BYPASS.
WHY IS TEG HELPFUL AFTER CABG CASE? WHAT DOES IT MEASURE?
DIAGNOSE WHETHER THE PATIENT IS DEFFICIENT IN A TYPE OF BLOOD COMPONENT AND IF THE HEPARIN IS FULLY REVERSED.
TEG EVALUATES CLOT FORMATION AND DESTRUCTION. (INTEGRETY OF CLOT CASCADE, PLT FUNCTION, PLT FIBRIN INTERACTIONS, FIBRINOLYSIS.)
HOW MUCH HEPARIN NEED TO BE GIVEN DURING SAPHENOUS VEIN PREPARATION?
5000 UNITS. THIS IS DEDUCTED FROM BYPASS DOSE. ALWAYS CONFIRM WHEN YOU ADMINISTER.
WHAT ARE HIGH LEVEL STIMULATION TIMES WHEN YOU SHOULD HAVE NARCOTIC READY?
INDUCTION
INCISION
STERNAL SPLIT AND SPREAD
AORTIC CANNULATION
DURING STERNOTOMY WHAT SHOULD YOU DO WITH VENT?
TAKE THEM OFF. LUNGS DOWN! CONFIRM REINFLATION OF BOTH LUNGS AFTER CHEST IS OPEN.
WHAT DO YOU NEED TO LOOK OUT FOR WHILE THEY ARE REMOVING SAPHENOUS VEIN?
THEY USE CO2 INSUFFLATION FOR REMOVAL SO KEEP AN EYE ON YOUR END TITAL.
