Scenario Flashcards
Baby N is 34 weeks gest age. Normal vaginal delivery. Meconium stained fluid, APGARS 1,1,5
Baby intubated, sx large amounts of meconium. PPV and taken to NICU.
2 hrs later baby decomps, cxr show bilat pneumothoraces. Pigtail caths placed
ECMO team called
Pre ECMO ABG
PT: 7.01 80 50 SpO2 78 b/p 38/20 map 28
ABG post staring vasopressors HFJV+INO
6.98 85 42 SpO2 70 b/p 35/19 map 23
1) besides starting meds and aggressive ventilation, what tests must be obtained before going on ECMO? Why?
Head ultrasound, cardiac ECHO, metabolic screen, baseline labs, cultures, cxr
2) your perfusionist arrives with the circuit. What items will they need?
Cannulation cart, 100 IU/kg of heparin, clamps, sterile instruments, dilators, blood, medications for the blood prime (ECMO priming kit from pyxis), open bed
3) what is your role in setting up circuit for patient?
Plug it in, plug in gas lines, make sure oxygen is hooked up, water for the heater/cooler, go through the pre-initiation checklist (access to laptop), getting the ECMO Specialist patient card to the room, do EQC for Hemochron Elite for ACTs
4) Patient is positioned on WT. Which side of the neck is prepped?
Right side
5) you are ready to go on ECMO
A- what things to check to confirm your circuit is ready?
B- how do you help the perfusionist?
A- the checklist!
B- Assistance
6) pump ABG 7.25 35 210 BE -7.0
A- what do you think the perfusionist will do?
A- nothing, look at patient gas. Sit tight, try to let acidosis work itself out
7) cannulation is complete. Art cannula: 10fr Venous cannula: 12fr
A- what would expect flow to be?
B- what would the range be?
C- what would the effect on flow be if cannulas were both 8fr
A- normal flow for infant/pediatric patient is 100-150 ml/kg, should hopefully get full flow with those cannulas
B- 350-525 ml/min
C- flows would drop due to increased resistance
8) First ABG (what would you expect to change?)
A- pt 7.52 32 52
B- pump 7.48 36 240. Pump sweep 0.4. Fio2 50% QB- 0.38
Decrease sweep, increase flow
