Ch. 12 Special Cases

Question 1

Debakey Classification of Thoracic Aortic Dissections

Answer 1

Type 1) from asc aorta to desc aorta
Type 2) only asc aorta
Type 3) only desc aorta (after L subclavian)

Question 2

Retrograde Cerebral Perfusion

Answer 2

flow < 500, SVC <25 mmHg

Question 3

Gott Shunt

Answer 3

directs from around XC to lower body during TAAA

Question 4

Left Heart Bypass

Answer 4

cannulate LA appendage, some BF directed to lower body

• heparin 100 units/kg= ACT 200
• BP 6- distal, 75% full flow

Question 5

anterior spinal artery syndrome

Answer 5

if vessels to spine occluded for too long

Question 6

Circ Arrest Drugs

Answer 6

-give bicarb, insulin, pentothal, florane

Question 7

Cooling Temps

Answer 7

Mild 32-37 C
Mod 28-31
Deep 18-28
Profound <18

Question 8

Circ Arrest Temps vs Time

Answer 8

32 C = < 10 min circ arrest
28 C = 10-15 min
18 C = 15-45 min
<18 C = 45- 60 min
*** rewarm with 8 C gradient

Question 9

Signs for Pulmonary Embolectomy

Answer 9

aO2<60, systolic BP<90, urine < 20 cc/hour

Question 10

Pregnancy- safest trimester?

Answer 10

• *2nd is safest
• fist- hypoxia, drugs
• third- labor, high uterus BF

Question 11

Pregnancy Parameters: HR, CBV, CI, BP, HCT, CO

Answer 11

HR: 80-90
CBV: 90-100 ml/kg
CI: 3-3.2 L/min/m2
BP: >65
HCT: 22-25% 
CO: incase 30-50% (20% to uterus)

Question 12

Heparin vs Coumadin for prego

Answer 12

heparin is ok= does not cross placenta

coumadin is NOT ok= crosses placenta (so don’t use mechanical valve that will need coumadin)

Question 13

Prego lay on left or right side?

Answer 13

lay on left side so not do stop vena cava drainage

Question 14

Cool or Don’t cool with prego bypass?

Answer 14

Don’t cool, it would lower fetal HR, and rewarming causes contractions
-want fetal 60 mmHg

Question 15

Which drugs to use for Hypertension and Hypotension

Answer 15

Treat hypotension= epinephrine (beta stimulator, no change in uterine flow)
-NOT neo/levarternol (alpha which changes uterine flow)
Treat hypertension= hydralazine (no uterine flow change)
-NOT nitroprusside (cyanide toxicity)

Question 16

What CPG to use with prego

Answer 16

Retrograde= use root vent to remove into waste bag so the CPG does not go into circulation to hurt fetus

Question 17

Hypothermia

Answer 17

= low respiration, low pulse

• correct with 4 C gradient per hour** start with same temperature as patient
• heparin fully! put half in prime incase not full circulation
• hemoconcentrate cuz renal failure
• correct acidosis
• lung injury
• cannulate fem-fem
• cardioconversion if a-fib once at 32C

Question 18

Jehovah’s Witness

Answer 18

no blood products= ultrafiltration, auto transfusion

• start with low prime volume,, coninous loop
• use hespan/dextran (no albumin) as volume expanders