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Final Written > Cardiothoracics > Flashcards

Cardiothoracics Flashcards

1
Q

Two lung positive pressure ventilation in lateral position - where are ventilation and perfusion the most

A

Ventilation more in non dependent lung

Perfusion greater in dependent lung

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2
Q

Positive pressure ventilation of ONLY dependent lung in lateral position

Which part of lung will have more

  • perfusion
  • ventilation
A

Dependent lung positive pressure ventilation
Perfusion at base
Ventilation at the top

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3
Q

Two lung ventilation lateral positive positive pressure ventilation where will the dead space be greatest

A

Non dependent lung

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4
Q

Act normal and for CPB

A

Normal 70-140

Act 4x normal or 480 for cpb

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5
Q

Act can be prolonged by

A 
Haemodilution 
Overfilling 
Inadequate mixing 
Thrombocytopenia 
Dilution or procoagulation deficiency
Warfarin 
Aprotonin
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6
Q

Absolute indications for OLV

A 
Prevention of infection or contamination ie BPF
Isolation pulmonary haemorrhage 
Control of distribution of ventilation 
Unilateral lung lavage
Giant unilateral Bullae 
Pneumonectomy
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7
Q

How does IABP work

A

Polyurethane Catheter into femoral artery and into descending aorta. Positioned distal to left subclavian but proximal to renal arteries

Helium inflates in time with mechanical cardiac cycle

Balloon deflated in systole when AV valve opens

Ballon inflates in diastole when AV valve closes

Inflation linked to mechanical cardiac cycle either times via ECG or IABP waveform or can be timed.

Support can slowly be weaned I.e 1 to 1 down to 1 to 3

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8
Q

What effect does IABP in diastole

A

Ballon inflates in diastole

This causes increase in diastolic blood pressure, increase in coronary blood flow and increase in myocardial oxygen delivery.

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9
Q

What effects of IABP in systole

A 
IABP deflates in systole 
Reduces SVR 
Reduces systolic blood pressure 
Reduces LV workload 
Reduces myocardial oxygen demand
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10
Q

Indications of IABP

A 
Cardiogenic shock 
Intractable angina 
Acute MI undergoing PTCA 
Reduced CO after cardiopulmonary bypass 
Ischaemic VSD 
Bridge to transplant
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11
Q

Contraindications to IABP

A

absolute Contraindications to IABP
Aortic regurgitation

Relation contraindications to IABP include 
Aortic aneurysms 
Severe peripheral vascular disease 
Uncontrolled coagulopathy
Uncontrolled sepsis 
Irreversible or terminal disease
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12
Q

Complications of IABP

A 
Aortic /iliac dissection 
Renal ischaemia 
Spinal cord ischaemia 
Thromboembolism 
Limb or distal ischaemia 
CVA 
Bleeding
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13
Q

Act volume and temp

A

Act 2ml and is incubated at 37 degrees

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14
Q

Effects of drugs of HPV

A

Volatiles and direct vasodilator inhibit HPV
Vasoconstrictors ie norad prefentially constrict vascular beds that have normal oxygen tensions - indirectly inhibits HPV

Ketamine fentanyl thio propofol no effect on HPV

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15
Q

Purpose of bypass

A

Bloodless field

Mainta8n oxygenation

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16
Q

Adverse effects CPB

A

Haemodilutiin (minimise circuit and prime volume)
Consumption coagulation factors (herparin)
Roller pump haemolysis(?centrifugal pump)
Activation leukocytes and d base balance (leucocyte filter)
Unctrolled blood loss (cell salvage)
Air embolism (vented blood filters)

17
Q

Centrifugal and roller pumps which is non occlusive

A

Centrifugal non occlusive and blood can go in either direction.
Preload and afterload dependent

18
Q

oxygenation in CPB

A

Membrane oxygenation
Other types disc
Bubble

19
Q

Minimal extracorpeal circulation aims to reduce prime volume with suction blood separation - how

A

Lack of reservoir
Lack of cardio time Suction

Closed circuit and involves little or no blood air contact
Reduced haemodilution and coagulation cascade

20
Q

Pre operative assesment of lung resection

A

Clinical ie more than 4 mets
Pulmonary function tests ie fev1 more than 1.5l in lobectomy and 2l pneumonectomy
Post op predicted values fev 1 and dlco more than 40%
Functional test ie 6minute walk test more than 400 yards
Cpex at more than 11 and vo2 max less than 15

21
Q

Management hypoxaemia in OLV

A 
Fio2 to 100 
Check ventilator and breathing apparatus 
Check DLT position 
Peep to dependent lung 
CPAP to top lung 
Intermittent two lung ventilation 
Clamp PA
22
Q

Primary and secondary causes of MR

A

Primary causes MR rheumatic heart and MVP

Secondary causes ischaemia and dilated cardiomyopathy

23
Q

Cause of SOB in MR

A 
Regurgitation blood in left atrium 
Increases LAP 
Pulmonary congestion 
Pulmonary hypertension 
Also get effects of AF
24
Q

Pharm agents in MR

A

Ace I
Diretics
Drugs for AF
Anticoagulation

25
Q

Investigations in mr

A

Echo
ECG
CXR
BNP

26
Q

Haemodynamic goals in MR

A

Full fast forward

Adequate preload
Fast normal hr 80 100
Low svr
Low pvr

Final Written (12 decks)

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