54. Cardiac surgery Flashcards
(23 cards)
PA insertion absolute contraindications
Tricuspid / pulmonary stenosis
Right ventricle / atrium masses
Tetralogy of fallot
Most common cause for CNS complications after cardiac surgery
Embolism (micro gaseous emboli)
Heparin MoA
Antithrombin (factor III) activation
Action of nitroprusside
Expansion of veins and arteries
False high BIS in
Pacemaker
Hypothermia
Pump head rotation
Avoid hexakapron in
Upper urinary system bleeding
TEG. Problem and treatment
R K alpha Max amplitude Lysis
R - coagulation factors - Protamine / FFP
K - fibrinogen - cryo
alpha - fibrinogen - cryo
M.A Plt - Ptl +- DDAVP
Lysis. Excess fibrinolysis - HexaK
Hemodynamic goals in Bypass
Blood flow: 1.6 -3 l/min/m2
CVP 0
MAP 50-90
SVO2 65%
Chronic MR and Treatment
Increase afterload and HR
Decrease preload
Best Ephedrin
HIT treatment
Bivalirudin (angiomax)
If kidney failure argatroban
Hb goals in bypass
Minimum 6-7 before after bypass
6 during bypass
Levosimendan MoA and effects
Ca sensitizer
Increase HR x1, Contractility x2, Peripheral vasoconstriction x3
Systolic anterior motion treatment
SAM — Volume
Eccentric vs concentric rebuilding
Eccentric volume overload (Chronic AR)
Concentric pressure overload
Most sensible part of aorta during TEE
The distal part of the ascending
Decrease SvO2
In Decrease CO, Hb, Sat
No if changes in VO2
Transcranial doppler
Measures the flow velocity of the middle cerebral artery
BIS measures
Cortical function of the frontal area only
Lysis of platelets and ACT
Shortens ACT
Protamine dosage
0.8 mg to 100 IU of heparin
Max dose 2.6
Protamine reactions
Type 1. decrease BP
Type 2. IgE. decrease in BP and brochospasm
Type 3. decrease BP + PHT
Vasoplegic syndrome
First line therapy for delirium after heart surgery
Haloperidol
