Immediate Postoperative Management (#3)

Question 1

What is the significance of pacing mode DOO/VOO?

Answer 1

License to KILL (007)
-only used in the OR when electrocautery would interfere with pacing signals, always check the pacemaker when pt comes back from OR.

Question 2

Why does the pump time matter?

Answer 2

> 160 min on-pump translates to increased risk of complications.

Question 3

what are -flurane drugs used for in cardiac surgery?

Answer 3

Inhaled drugs used for muscle relaxation and sedation.

Question 4

What are the 2 reversal agents for NMB? What does that pt need to have prior to reversal?

Answer 4

Glycopyrrolate and Neostigmine

Pt must have some return of neurmuscular function (1/4 twitches.)

Question 5

Watch out for MALIGNANT HYPERTHERMIA, 2 signs include?
What is the physiology of MH?
What is the treatment?

Answer 5

-hyperthermia, tetany
Trigger agent (sometimes a NMB) affects calcium homestasis and there is massive calcium release 
-treatment drug is dantrolene and supportive care, avoid rapid rewarming.

Question 6

3 risks of post op nausea/vomiting?

Answer 6

1) increases aspiration risk
2) electrolyte disturbances
3) suture disruption

Question 7

why is it important to keep the patient > 36 degrees?
B
D
S
M

Answer 7

B-Bleeding
D-Dysrhythmias
S- shivering(increased MVO2),
M -masks hypovolemia

Question 8

How much bleeding from the chest tube is too much?

Answer 8

>500 mL in the 1st hour
>400mL/hour in the 2nd hour
>300mL/hour in the first 3 hours
>200 mL/hour in the first 6 hours
>1 liter in the first 24 hours

Question 9

Prolonged PTT (>39 seconds) indicates what?
What is the reversal agent?

Answer 9

Heparin activity

Protamine

Question 10

Prolonged PT/INR (>12seconds/>1.5) indicates what?

What is the treatment?

Answer 10

Indicates a decrease in clotting factors

treatment is giving FFP.

Question 11

Fibrinogen < 200 indicates what?

WHat is the treatment?

Answer 11

decrease in clotting factors

FFP, cryoprecipiate

Question 12

What is DDAVP indicated for?

Answer 12

Bleeding - promotes platelet aggregation/adhesion

Question 13

What do increased peak inspiratory pressures indicate?

Answer 13

Increased resistance to air flow (secretions/biting/bronchospasm)

Question 14

What do increased plateau pressures indicate?

Answer 14

Decreased lung compliance (pulmonary edema, ARDS, , PNA, shivering, Auto-PEEP)

Question 15

RSBI =

Answer 15

RSBI = f/vt
frequency of breaths
tidal volume
should be < 105 for successful ventilator weaning.

Question 16

successful NIF for extubation?

Answer 16

less than 25 cm H20