Exam 3 Flashcards
During placement of lines in preparation for heart surgery which heart rhythm contradicts PAC placement?
LBBB, remember PAC placement can cause RBBB leading to CHB in a patient with LBBB
What type of injuries are common during heart surgery?
brachial plexus, ulnar, radial, occipital alopecia
What is the typical dose of heparin to get on pump?
400 units/kg
What are the three A’s to prepare for sternal incision?
Anesthesia, analgesia, antibiotics, paralysis
What is the most common time period for awareness and recall?
sternal spilt (ensure 1 MAC)
What should you do to the ventilator during sternal split??
deflate lungs and cut PEEP
Is radial artery dissection high or low level stimulation
low
Which types of nerves are dissected from the aorta?
postganglionic sympathetic
What is the most common cause of hypotension before CBP?
hypovolemia
What is the ACT goal for bypass?
>400 seconds
When do you first draw a ACT and then how often?
3-5 minutes after first bolus, then every 20-30min
What do you do if ACT is <400 after heparin?
give 10-20,000 more, FFP, AT3
What are your options if your patient has HIT?
postpone surgery, Bivalrudin
Tell me about Heparins charge, pH, and MOA.
negative charge, acidic, binds AT3 and increases AT3’s inhibitory action on thrombin 1000x
Tell me about Protamines charge, pH, dose and MOA.
postive charge, basic, 1mg protamine to 100 units Heparin, forms ionic bonds with heparin molecule
What are signs of protamine reaction?
pulm HTN, elevated CVP, HoTN, RV failure, CV collapse
Which cannula is always placed first?
Aortic
What is your BP goal before the aortic cannula is placed?
SBP 90-100
Where is the retrograde cardioplegia cannula placed?
coronary sinus
Where is the LV vent placed?
right pulmonary vein
What is the most common approach for arterial cannulation?
in the distal ascending aorta and directed toward the transverse arch
What type of central venous cannula is usually inserted for CABG and AV repair?
Cavoatrial (two stage) single cannula
What is the cavoatrial cannula?
single cannula drawing from the RA and distal IVC, inserted through the atrial appendage
Where are Bicaval cannulas placed?
SVC and IVC
Which type of central venous cannulation is most effective at diverting blood away from the heart?
Bicaval
Venous cannulation occurs in which sites?
femoral vein, IJ and positioned to sit in the SVC and RA junction
What is represented by the TEG graph?
Normal
What is represented by the TEG graph?
factor deficiency or anticoagulation
What is represented by the TEG graph?
impaired platelet number or function
What is represented by the TEG graph?
primary fibrinolysis
What is represented by the TEG graph?
hypercoagulation
What is represented by the TEG graph?
DIC stage 1
hypercoagulable with secondary fibrinolysis
What is represented by the TEG graph?
DIC stage 2
hypercoagulable state
