Post-operative care of Cardiac Surgery patients Flashcards

Question

What is Kussmaul's sign?

Answer 1

A paradoxical rise in the JVP with inspiration, can be a sign of constrictive pericarditis, restrictive cardiomyopathy, PE, cardiac tumours, right heart failure

Answer 2

A drop of systolic BP of more than 10mmHg during inspiration, can be a sign of severe COPD, OSA, croup, constrictive pericarditis. It is due to a number of factors. During inspiration, right heart filling increases but left heart filling decreases, this results in reduced preload to the LA and LV, additionally, the negative intrathoracic pressure, increases the LV to thoracic transmural pressure gradient, which increases the afterload of the LV. In constrictive pericarditis, with equalization of the cardiac chamber pressures, the effect of increased RV filling pushes against the LV causing reduced LV preload and even more reduction in BP.

Answer 3

5%, this risk increases to 14% in COPD patients and 10% in patients with previous stroke

Answer 4

after 14 days

Answer 5

CHF history, Hypertension, Age >75, Diabetes, Stroke or TIA previously Score 0-1 = ASA or nothing, 2+ = anticoagulation recommended

Answer 6

CPB causes hypothermia, hemodilution, ischemia re-perfusion injury and the release of inflammatory cytokines and microparticle emboli from trauma to blood constituents. These factors can adversely affect renal function post-operatively. Operative considerations include limiting the duration of CPB and maintaining MAPs greater than 60mmHg. Beyond optimizing hemodynamics and avoiding nephrotoxic medications, there is no evidence that other treatment is renoprotective post-op.

Answer 7

``` ionized Ca 1.14–1.28 mmol/L total Ca 2.12–2.52 mmol/L (affected by serum albumin) K 3.5–5.1 mmol/L PO4 0.81–1.58 mmol/L Mg 0.74–1.03 mmol/L ```

Answer 8

Cardioplegia, decreased urine output, decreased insulin levels and RBC hemolysis contribute to hyperkalemia

Answer 9

<180 mg/dL

Answer 10

When there is unexplained prolonged vasodilatory shock

Answer 11

1-4% and higher in carotid stenosis >50%, redo surgery, valve surgery, prior stroke, age, calcified aorta, duration of CPB

Answer 12

Urgent CTA. Endovascular therapy is an option if performed within 6-8 hours of the event or up to 24 hours in patients with posterior circulation occlusion.

Answer 13

Up to 50% of cardiac surgery patients experience delirium. Risk factors include pre-existing organic mental health disorders, prior alcohol consumption, age, intracranial cerebral artery disease, benzodiazepines, opiates, anticholinergics, phenothiazines

Answer 14

Brachial plexus injury - excessive retraction of sternotomy or injury during IMA harvest Ulnar nerve injury - malpositioning of upper arms Saphenous nerve injury - during vein harvest

Answer 15

Mesenteric ischemia, GI bleeding, pancreatitis, acute acalculous cholecystitis, dysphagia (from intubation/TEE), ileus, Ogilvie's syndrome

Answer 16

Increased length of CPB, vasopressors, IABP, a-fib, PAD, HIT. Mortality is 50% with early surgical intervention (<6 hours) and 99% with delay in surgical intervention.

Answer 17

3.2%, fever is a poor predictive of post-operative bacteremia

Answer 18

Diabetes, obesity, females, large breasts, bilateral IMA harvesting, low serum albumin, CKD, blood transfusions, COPD, hyperglycemia, prolonged CPB, blood transfusions, re-operations

Answer 19

Hibiclens wash, clipping of hair, antibiotic prophylaxis, good intra-op hemostasis without bone wax, subcuticular sutures and dermabond rather than skin staples, good glucose control

Answer 20

Minor - intravenous antibiotics, wound care | Deeper infections - 6 weeks of IV antibiotics, surgical exploration and debridement, VAC therapy

Answer 21

``` 3 or more high dose - 75% 2 high dose - 30% 1 high dose - 18% 1 moderate dose - 8% 1 low dose - 5% none - 2% ```