Blue Book

Question 1

aneurysm definition

Answer 1

expansion of the wall of a blood vessel

Question 2

what is an aneurysm caused by

Answer 2

atherosclerosis: build up of plaque on the inside of an artery
hypertension
injury
infection
marfan's syndrome
pregnancy

Question 3

aneurysms of the aorta may rupture immediately causing what?

Answer 3

loss of systemic blood flow volume and pressure

Question 4

dissection definition

Answer 4

tear in the layers of the aortic wall causing blood to flow between the layers of the aorta

Question 5

how is arterial blood pressure ideally monitored in an aortic arch repair

Answer 5

left radial art line and femoral line

Question 6

why is the left radial used and not the right?

Answer 6

the right may be compromised by the clamping on the ascending aorta since the right radial arises from vessels off the innominate arty which is often too close to affected area

Question 7

when there is a dissecting thoracic aortic, what may become obstructed coming off the aorta?

Answer 7

cerebral, coronary, renal and peripheral vessels

Question 8

what will you see if there is a dissection during cardiac surgery?

Answer 8

the arterial perfusion line pressure may rise immediately and then possibly fall as the dissection extends

Question 9

describe debakey’s classification of thoracic aortic dissections

Answer 9

Type 1: begins in the ascending aorta just above the aortic valve and extends into the descending aorta

type 2: includes the ascending aorta only

type 3: originates distal to the left subclavian artery and involves the descending aorta only

Question 10

what the device that is used to monitor the oxygen saturation in both sides of the brain?

Answer 10

cerebral oximeter

Question 11

what can the cerebral oximeter help the perfusionist measure?

Answer 11

indirect assessment of the cerebral blood flow

Question 12

what are some “cons” of the clamp and go method for descending thoracic and thoracoabdominal aneurysms?

Answer 12

• kidneys, liver, and gastrointestinal regions are not perfused
• left ventricle must eject against a clamped aorta, which can increase after load of the left ventricle (blood left in the ventricle after ejection)
• anterior spinal artery syndrome

Question 13

Temperatures of _____ degrees C and below are thought to cause cessation of the brain’s electrical activity and provide optimal protection

Answer 13

15 degrees C

Question 14

Some research shows that hyperglycemia in circulatory arrest patients may cause damage to the central nervous system. Therefore, what should be give to the patient?

Answer 14

Insulin should be given if blood glucose levels rise too high prior to circulatory arrest

Question 15

what other drugs are given to patients undergoing circulatory arrest?

Answer 15

sodium Pentothal: causes the brain’s electrical activity to decrease

forane: barbiturate effect on the brain (sedative or sleep-inducing drug)

Question 16

A temperature gradient less than __ should be maintained during rewarming. Why?

Answer 16

less than 8 degrees.

More oxygen is held in solution in cold blood, and warming the patient to rapidly may cause micro bubbles

Question 17

mild temperature

Answer 17

32-37

Question 18

moderate temperature

Answer 18

28-31

Question 19

deep temperature

Answer 19

18-28

Question 20

profound temperature

Answer 20

0-18

Question 21

if the patient is 32 degrees C, what should the arrest period be?

Answer 21

under 10 min

Question 22

if the patient is 28 degrees C, what should the arrest period be?

Answer 22

10-15 min

Question 23

if the patient is 18 degrees C, what should the arrest period be?

Answer 23

16-45 min

Question 24

if the patient is under 18 degrees C, what should the arrest period be?

Answer 24

46-60 min

Question 25

what is a pulmonary embolism and what can it cause?

Answer 25

embolism may be a blood clot, fat, air or debris result in circulation to a lung being stopped or compromised

Question 26

in patients who are rapidly deteriorating from pulmonary embolism, what surgery might be done?

Answer 26

pulmonary embolectomy

Question 27

what are indicators that a patient may need emergency surgery to remove embolus?

Answer 27

- arterial pO2 less than 60 mmHg - systolic blood pressure less than 90 mm Hg - urine output less than 20 cc an hour

Question 28

what are the most common problems that occur during pregnancy?

Answer 28

valvular disorders

Question 29

when is the safest period for the mother and the fetus for the surgery to be performed?

Answer 29

second trimester

Question 30

why is the first trimester dangerous for surgery?

Answer 30

the embryo is easily injured by hypoxemia, drugs, and other factors

Question 31

why is the last trimester dangerous for surgery?

Answer 31

premature labor can occur | also, the blood volume of the fetus and the output directed to the uterus is at its greatest

Question 32

does heparin cross the the placental barrier?

Answer 32

NO | heparin does not cross the placenta

Question 33

what anticoagulant does?

Answer 33

Coumadin

Question 34

if a mitral valve is necessary, what valve must be used on the pregnant patient?

Answer 34

porcine valves that do not require anticoagulants

Question 35

why are pregnant patients not cooled?

Answer 35

because the fetal heart rate would decrease and uterine contractions may be precipitated by rewarming

Question 36

what is the BPM that the fetus must stay in range of when on bypasss?

Answer 36

60 BPM

Question 37

what are the flows on a pregnant patient?

Answer 37

- flows are maintained high | - cardiac index of 3 to 3.2 L/min/M sq may be necessary to ensure the fetal heart beat is kept above 60 BPM

Question 38

what should the mother's blood pressure be kept at to provide optimal flow to the uterus?

Answer 38

65 mmHg

Question 39

what should be used to increase the pressure while on bypass for a pregnant patient?

Answer 39

epinephrine

Question 40

what drugs should not be used on bypass? and why?

Answer 40

neosynephrine and levarterenol these drugs are alpha agonists and can compromise blood flow to the uterus

Question 41

what drug should be used for hypertension on a pregnant patient?

Answer 41

hydralazine

Question 42

what drug should NOT be used for hypertension on a pregnant patient? and why?

Answer 42

sodium nitroprusside cyanide toxicity possible and its effect of the fetus

Question 43

what are cold agglutinins or cryoproteins?

Answer 43

antibodies that work on the antigens found on the surface of red blood cells that cause complement activation and red blood cells to clump at low temperatures and break down

Question 44

what antibody class are usually the one where the agglutination is significant?

Answer 44

IgM

Question 45

if a patient must be cooled to temperatures that may cause a reaction, what is necessary?

Answer 45

plasmapheresis

Question 46

if cold cardioplegia is desired for a cold agglutinins patients, what type should be used?

Answer 46

plain crystalloid

Question 47

what is cannulation for a hypothermia patient?

Answer 47

femoral artery and femoral vein

Question 48

what should the setup of the circuit be for hypothermia patients?

Answer 48

- half of heparin should be circulated in the pump prime if the ability of the patient to circulate the heparin is in question - ultrafiltrator is used to control volume status and because of the possibility of ensuing renal failure - oxygenator will help the patient if they may be in an acidotic state - temperature of the priming solution should be near the patient's core temperature when bypass is initiated

Question 49

how fast should hypothermia patients be warmed?

Answer 49

rewarmed at a rate of 4 degrees an hour to ensure adequate recovery time and uniform rewarming

Question 50

what should be done when a hypothermia patient starts fibrillating during rewarming?

Answer 50

cardioversion should be attempted when the core temperature has reached 32 C

Question 51

what is the goal when performing CPB on Jehovah's Witness patient?

Answer 51

strict blood conservation autotransfusion, ultrafiltration, and return of the chest tube output

Question 52

what should be taken into consideration when setting up a pump for Jehovah's Witness patient?

Answer 52

- minimizing the pump circuit and priming volume - blood is returned to patient in a continuous loop by connecting cell save or chest tube directly in line to an IV site for direct infusion

Question 53

what drugs can be given to manage blood?

Answer 53

hespan or dextran may be given as plasma expanders