Exam 3

Question 1

During placement of lines in preparation for heart surgery which heart rhythm contradicts PAC placement?

Answer 1

LBBB, remember PAC placement can cause RBBB leading to CHB in a patient with LBBB

Question 2

What type of injuries are common during heart surgery?

Answer 2

brachial plexus, ulnar, radial, occipital alopecia

Question 3

What is the typical dose of heparin to get on pump?

Answer 3

400 units/kg

Question 4

What are the three A’s to prepare for sternal incision?

Answer 4

Anesthesia, analgesia, antibiotics, paralysis

Question 5

What is the most common time period for awareness and recall?

Answer 5

sternal spilt (ensure 1 MAC)

Question 6

What should you do to the ventilator during sternal split??

Answer 6

deflate lungs and cut PEEP

Question 7

Is radial artery dissection high or low level stimulation

Answer 7

low

Question 8

Which types of nerves are dissected from the aorta?

Answer 8

postganglionic sympathetic

Question 9

What is the most common cause of hypotension before CBP?

Answer 9

hypovolemia

Question 10

What is the ACT goal for bypass?

Answer 10

>400 seconds

Question 11

When do you first draw a ACT and then how often?

Answer 11

3-5 minutes after first bolus, then every 20-30min

Question 12

What do you do if ACT is <400 after heparin?

Answer 12

give 10-20,000 more, FFP, AT3

Question 13

What are your options if your patient has HIT?

Answer 13

postpone surgery, Bivalrudin

Question 14

Tell me about Heparins charge, pH, and MOA.

Answer 14

negative charge, acidic, binds AT3 and increases AT3’s inhibitory action on thrombin 1000x

Question 15

Tell me about Protamines charge, pH, dose and MOA.

Answer 15

postive charge, basic, 1mg protamine to 100 units Heparin, forms ionic bonds with heparin molecule

Question 16

What are signs of protamine reaction?

Answer 16

pulm HTN, elevated CVP, HoTN, RV failure, CV collapse

Question 17

Which cannula is always placed first?

Answer 17

Aortic

Question 18

What is your BP goal before the aortic cannula is placed?

Answer 18

SBP 90-100

Question 19

Where is the retrograde cardioplegia cannula placed?

Answer 19

coronary sinus

Question 20

Where is the LV vent placed?

Answer 20

right pulmonary vein

Question 21

What is the most common approach for arterial cannulation?

Answer 21

in the distal ascending aorta and directed toward the transverse arch

Question 22

What type of central venous cannula is usually inserted for CABG and AV repair?

Answer 22

Cavoatrial (two stage) single cannula

Question 23

What is the cavoatrial cannula?

Answer 23

single cannula drawing from the RA and distal IVC, inserted through the atrial appendage

Question 24

Where are Bicaval cannulas placed?

Answer 24

SVC and IVC

Question 25

Which type of central venous cannulation is most effective at diverting blood away from the heart?

Answer 25

Bicaval

Question 26

Venous cannulation occurs in which sites?

Answer 26

femoral vein, IJ and positioned to sit in the SVC and RA junction

Question 27

What is represented by the TEG graph?

Answer 27

Normal

Question 28

What is represented by the TEG graph?

Answer 28

factor deficiency or anticoagulation

Question 29

What is represented by the TEG graph?

Answer 29

impaired platelet number or function

Question 30

What is represented by the TEG graph?

Answer 30

primary fibrinolysis

Question 31

What is represented by the TEG graph?

Answer 31

hypercoagulation

Question 32

What is represented by the TEG graph?

Answer 32

DIC stage 1

hypercoagulable with secondary fibrinolysis

Question 33

What is represented by the TEG graph?

Answer 33

DIC stage 2

hypercoagulable state