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Congenital Defects (exam 1) > Topic 2 > Flashcards

Topic 2 Flashcards

1
Q

When does the myocardium matures?

A

3-12 months

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2
Q

Neonates utilize what type of oxidation?

A

glucose oxidation

Immature myocardium prone to “stretch injury”

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3
Q

Neonatal: age range

A

< 30 days

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4
Q

Pediatric:

A

up to 18 yo (< 18)

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5
Q

Adults have what type of energy source that peds dont?

A

fatty acid dependent energy source

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6
Q

Adult characteristics different from peds?

A

Adult circuits tend to be “one size fits all”
Many adult organ systems have acquired disease
Some organ systems have failed
Adults have fatty acid dependent energy source
Not affected as much by prime volume dilution
Mature clotting cascade and organ systems
Utilize mostly alpha-stat and some pH-stat blood gas management

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7
Q

Weight < 10kg

what is Blood Volume (cc/kg)?

A

< 10kg

85 cc/kg

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8
Q

WT 11-20 kg

what is Blood Volume (cc/kg)?

A

80 cc/kg

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9
Q

WT 21-30 kg

what is Blood Volume (cc/kg)?

A

75 cc/kg

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10
Q

WT 31-40 kg

what is Blood Volume (cc/kg)?

A

70 cc/kg

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11
Q

WT > 40 kg

what is Blood Volume (cc/kg)?

A

65 cc/kg

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12
Q

Neonatal Pack sizes?

A

3/16” x ¼”

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13
Q

Infant Pack sizes?

A

¼” x ¼”

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14
Q

Pediatric Pack sizes?

A

¼” x 3/8”

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15
Q

Small Adult Pack sizes?

A

3/8” x 3/8”

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16
Q

Adult Pack sizes?

A

3/8” x ½”

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17
Q

Steps in choosing Pediatric Circuit ? (9)

A
  1. Determine BSA (kg weight may suffice)
  2. Determine maximum flow rate (KG weight based or BSA based)
  3. Choose appropriate pump boot
  4. Pick arterial cannula
  5. Determine arterial line size
  6. Pick venous cannula
  7. Determine venous line size *Packs (1/8” x 3/16”, 3/16”x3/16”, 3/16”x ¼”, ¼” x ¼”, ¼”x3/8”, 3/8”x3/8”, 3/8”x½”)
  8. Choose oxygenator
  9. Choose arterial filter
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18
Q

Wt (kg): 0-3 kg

Flow (cc/kg/min) ?

A

200 cc/kg

kg weight x cc/kg/min flow = maximum flow

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19
Q

Wt (kg): 3-10 kg

Flow (cc/kg/min) ?

A

150 cc/kg

kg weight x cc/kg/min flow = maximum flow

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20
Q

Wt (kg): 10-15 kg

Flow (cc/kg/min) ?

A

125 cc/kg

kg weight x cc/kg/min flow = maximum flow

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21
Q

Wt (kg): 15-30 kg

Flow (cc/kg/min) ?

A

100 cc/kg

kg weight x cc/kg/min flow = maximum flow

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22
Q

Wt (kg): >30 kg

Flow (cc/kg/min) ?

A

75 cc/kg

kg weight x cc/kg/min flow = maximum flow

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23
Q

Wt (kg): >55 kg

Flow (cc/kg/min) ?

A

65 cc/kg

kg weight x cc/kg/min flow = maximum flow

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24
Q

Boot Diameter 3/16
Stroke Volume/Revolution (cc)?
MAX VENOUS CALCULATED BFR (mLmin)?

A

7cc

1100 mL/min

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25
Q

Boot Diameter 1/4”
Stroke Volume/Revolution (cc)?
MAX VENOUS CALCULATED BFR (mLmin)?

A

13cc

2000 mL/min

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26
Q

Boot Diameter 3/8”
Stroke Volume/Revolution (cc)?
MAX VENOUS CALCULATED BFR (mLmin)?

A

27cc

6500 mL/min

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27
Q

Boot Diameter 1/2”

Stroke Volume/Revolution (cc)?

A

45cc

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28
Q

Reynolds Number

A

Density Velocity Diameter of pipe/Viscosity of fluid

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29
Q

Poiseuille’s law can be used to calculate volume flow rate only in the case of laminar flow
Flow =

A

ΔP x πr4 / L x V x 8

30
Q

Arterial Cannulae selection Aim? Pressure drop?

A

Aim: utilize the smallest cannula w/ the highest flow rate
Do NOT exceed pressure drop> 100 mmHg
Critical velocity is reached when laminar flow becomes turbulent (Reynolds #)
Higher pressures = higher sheer stress = hemolysis = bad

31
Q

Venous Cannulae selection Aim? Pressure drop?

A

Aim: drain the patient with the smallest cannulas
Be aware if the cannulation is bicaval or single atrial cannula
Pressure drop is in the -30 to -40 range (pressure-flow curve)
Vacuum Assist Venous Drainage (VAVD) may help but at a cost (micro-emboli may be associated with VAVD)

32
Q

Since all venous return essentially goes to the RA: Approximately 100% can be drained by what kind of cannulae?

A

a single venous cannula

33
Q

Terumo Baby RX05 max flow and prime volume?

A

1.5 L/m

43 cc

34
Q

Sorin Kids D100 oxygenator max flow and prime volume?

A

0.7 L/m

31 cc

35
Q

Terumo RX10 oxygenator max flow and prime volume?

A

4.0 L/m

135 cc

36
Q

Terumo RX15 oxygenator max flow and prime volume?

A

5.0 L/m

135

37
Q

Capiox Infant ALF - flow range?

A

<2500 ml/min

38
Q

Intersect Pediatric ALF - flow range?

A

> 2500 to < 3000 ml/min

39
Q

Gish ALF - flow range?

A

> 3000 ml/min

40
Q

Pall Leuco-Guard 3 ALF for Transplant Cases flow range?

A

<3000 ml/min

41
Q

Pall Leuco-Guard 6 Criteria for Transplant Cases flow range?

A

> 3000 to <6000 ml/min

42
Q

flow range for single atrial cannulae?
flow range for bicaval cannulation?
3/8” x 3/8”

A

Single: > 2898 to < 3500 ml/min

Bicaval: >3000 to < 3500 ml /min

43
Q

flow range for single atrial cannulae?
flow range for bicaval cannulation?
¼” x 3/8”

A

single atrial > 1278 to 2898

Bicaval. 1566 to <3000 ml/ min

44
Q

flow range for single atrial cannulae?
flow range for bicaval cannulation?
¼” x ¼”

A

single atrial: > 800 to 1278

Bicaval : 800 to <1566 ml/min

45
Q

flow range for single atrial cannulae?
flow range for bicaval cannulation?
3/16” x ¼”

A

single and bicavL <800 ml/min

46
Q

flow range for single atrial cannulae?
flow range for bicaval cannulation?
3/8” x ½”

A

single atrial > 3500 ml/min

bicaval > 3500 ml/min

47
Q

Adults Basic Prime Constitutes (6)

A 
Normosol
Hetastarch/Albumin
Antibiotic
NaHCO3
Mannitol
Heparin 10 K units
48
Q

Pediatric Basic Prime Constitutes (9)

A 
Normosol
25% Albumin
Antibiotic
Solumedrol
NaHCO3
Heparin 100 units
Mannitol
CaCl
PRBC’s
49
Q

25% Albumin

A 
Large molecule
Aids passification of tubing
Elevates C.O.P. and serum osmolarity
Good osmotic “pull” from tissues (1.3:1)
Be careful in recommendations
(i.e X-coating calls for wetting with crystalloid 1st)
50
Q

Cefazolin (Kefzol, Ancef) Dose?

A

Antibiotic

25 mg/kg (max dose = 1 g)

51
Q

Ampicillin Dose?

A

Antibiotic

50 mg/kg (max dose = 1 g)

52
Q

Gentamicin Dose?

A

Antibiotic

2 mg/kg (max dose = 80 mg)

53
Q

Nafcillin Dose?

A

Antibiotic

25 mg/kg (max dose = 1 g)

54
Q

Vancomycin Dose?

A

Antibiotic

10-15 mg/kg (max dose = 1 g)

55
Q

Solumedrol (methyprednisolone) pump prime may contain what amount – for peds and adults?

A

The pump prime may contain 30 mg/kg methylprednisolone (up to 500 mg) on all to patients undergoing procedures requiring CPB.
Pediatric transplant patients receive 30 mg/kg methylprednisolone when the aortic crossclamp is released.

56
Q

NaHCO3 pump prime should contain what amount?

A

The prime should have a bicarbonate concentration of approximately 24 mEq/L

57
Q

The amount of NaHCO3 necessary for a given amount of asanguineous volume – how do you calculate?

A

where x = mEq NaHCO3 and V =mL asanguineous volume:

x = 0.025V

58
Q

If PRBC’s are added to the prime, then a sample should be taken, and NaHCO3 administered according to the following formula:

A

?mEq NaHCO3 = 0.3(kg wt)(BE)

59
Q

Mannitol what does it do?

A

Osmotic dieuretic
Elevates Osmolarity rapidly
Given over a range of medical disciplines
Oxygen radical scavenger
0.25 g/kg in the prime
An additional 0.25 g/kg is administered on the release of the aortic cross-clamp

60
Q

Mannitol Dose, in prime and additional doses

A

.25 g/kg in the prime
An additional 0.25 g/kg is administered on the release of the aortic cross-clamp
Since mannitol is 25% solution (5.3 kg x .25 = 1.325 g) And that is 5.3 cc

61
Q

CaCl2 - normal values?

A

Not routinely added to the prime. However, an ionized Ca++ level of the perfusate should be measured shortly after the initiation of CPB and corrected upward to 0.7-0.8 mM/L, if necessary.
This is imperative because a level of 0.7 to 0.8
mM/l would allow the appropriate level to be present in the cardioplegia solution of a standard 4:1 solution

62
Q

<10 kg intravascular bld vol index?

A

85mL/kg

63
Q

> 10 kg to <20 kg - intravascular bld vol index?

A

80 mL/kg

64
Q

> 20 kg to <30 kg - intravascular bld vol index?

A

75mL/kg

65
Q

> 30 kg to <40 kg - intravascular bld vol index?

A

70mL/kg

66
Q

> 40 kg - intravascular bld vol index?

A

65 mL/kg

67
Q

For neonates/infants < 5kg, what is given to avoid a prolonged period a asanguineous perfusion.

A

100 ml PRBC’s are added to the prime

68
Q

TEG

A

Sporatic use in Or/Perfusion labs
Takes a long time to finalize (takes patience)
Looks at the larger spectrum
Viscoelastic test on whole blood –rotates specimen in cuvette every ten seconds

69
Q

Platelet Works

A

Assesses platelet function and compares functional and
non-functional platelets by percentage (%)
More useful due to looks at function, not number

70
Q

CDI in-line analyzer

A

Standard of care
Important in pediatrics
pH stat or Alpha stat use

71
Q

(NIRS) Near-infrared spectroscopy

A

NIRS technology, such as that used in pulse oximetry, has been used and trusted in the world of medicine for decades
Is a spectroscopic method that uses the near-infrared region of the electromagnetic spectrum (from about 800 nm to 2500 nm)

Congenital Defects (exam 1) (4 decks)

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