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Perf Tech > test 9 > Flashcards

test 9 Flashcards

1
Q

Thermoreceptors in the skin

A

 Causes hypothalamus to trigger sympathetic nervous
system response
 Vasoconstriction of the skin vessels which decreases loss of heat by convection (move it all to core)
 Vasodilation of skeletal muscle vascular beds (shiver)

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2
Q

Endocrine

A

 Oxygen consumption increases
 HR Increases
 CO Increases
 BP Increases

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3
Q

why use hypothermia

A
  1. buys time in case you need to stop blood flow

2. safety mechanism if something fails

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4
Q

why does hypothermia protect

A

 Reduces metabolic rate (enzyme rxn slowed)
 Reduces oxygen consumption
 Helps preserve high energy phosphate stores
 Reduces excitatory neurotransmitter release

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5
Q

general affects of hypothermia

A

 Allows lower pump flows
 Better myocardial protection
 Less blood trauma
 Better organ protection

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6
Q

mild hypothermia temp range

A

32-35°

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7
Q

moderate hypothermia temp range

A

28-31°

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8
Q

Deep Hypothermia temp range

A

18-27°

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9
Q

Profound Hypothermia temp range

A

< 18°

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10
Q

Alteration to Organ Function

A 
 Decreased blood flow to all organs:
    Greatest: Skeletal Muscle / Extremities
    Kidneys
    Splanchnic Beds
    Heart
    Brain
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11
Q

Heart function due to hypothermia

A

 Heart rate – Decreased
 Contractility – same or increased
 Dysrhythmias

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12
Q

Lung function due to hypothermia

A

 Decrease in ventilation

 Gas exchange is unaffected

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13
Q

tepid hypothermia

A

35-37°

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14
Q

surgeries using mild hypothermia

A
  • Aortic valve replacement

- most CABG

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15
Q

surgeries using moderate hypothermia

A
  • valve and a CABG
  • Mitral valve
  • Davinci
  • ascending aortic annurysms
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16
Q

surgeries from moderate down

A

-surgeries for kids

17
Q

Kidney function due to hypothermia

A

 Largest proportional decrease in blood flow
 Decrease in active transport
 Won’t reabsorb water
 Hemodilution and hypothermic bypass improves renal blood flow and protects renal tubules post operatively

18
Q

Liver function due to hypothermia

A

 Blood flow is reduced in proportion to the reduction in cardiac output
 ⬇ in metabolic and excretory function of the liver
 Drug actions / requirements

19
Q

Hyperglycemia

A

 Feature of hypothermic CPB
 Decreased insulin production (decrease metabolic function of pancreas)
 Give dextrose to increase glucose levels

20
Q

SVR increases

A 
 Increase in viscocity
 Increase in catecholamines (Epi, NE)
 Hemoconcentration
 Cell Swelling
 Thoroughfare channel
 Further decrease in oxygen delivery to the tissues
 Thrombocytopenia
21
Q

Methods of Hypothermia

Induction

A

 Surface Cooling
 Core Cooling
 Deep Hypothermic Total Circulatory Arrest

22
Q

When to use Surface Cooling

A

 Small infants less than 2.5 to 3.0kg

 Myocardial protection on adults and peds

23
Q

when to use Profound hypothermia with arrest

A

 Repair complex congenital heart defects – small infants
and children
 Operations involving the aortic arch

24
Q

If arrest period longer than 60 minutes

A

 Use intermittent arrest with brief periods of hypothermic
flow
 Low-flow hypothermic perfusion is safer than total arrest

25
Q

Q10 Principle

A

 Q10 = relates the increase or decrease in reaction
rates or metabolic processes to a temperature
change of 10˚C.

26
Q

Reduction in Metabolic Rate

A

 reduced oxygen demand by 50% for every 7°C drop in temperature

27
Q

as pressure increases what happens to solubility of gas

A

increases

28
Q

as temperature increases what happens to the solubility of gases

A

decreases

29
Q

as temp increases, what happens to solubility and partial pressure

A
  • Decreased solubility

- Increased partial pressure

30
Q

Rate of cooling

A

 Cool at 1°C per minute

31
Q

rate of warming

A

 Warm at 1°C per 3-5 minutes

32
Q

Consequences of Cooling / Warming too fast

A

 Development of temperature gradients within tissues
 Body cooling after bypass
 Exposure to hyperthermia

33
Q

Rate of Cooling / Warming Limitations

A

 Water temperature in heat exchanger
 Blood pressure and systemic vascular resistance
 Flow Rate

34
Q

Rewarming

A

-rewarm slowly so that the peripheral vascular beds open up
 Use tools to help you rewarm (after AoXC removal)
 Bair Hugger
 Warming Blanket

Perf Tech (6 decks)

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