Dance Steps Flashcards
(28 cards)
What is the goal blood pressure with aortic cannulation for bypass?
What is the goal ACT for aortic cannulation?
90-100
>300
What must you expect if there is increased aortic cannula pressures during aortic cannulation for bypass?
aortic dissection
What is considered adequate systemic heparinization for bypass? For pump suckers? To stay on Bypass?
Ie. ACT
> 480
250
400
Where is the LV vent placed?
superior pulmonary vein
What is the line called that administers antegrade cardioplegia?
root vent
When is retrograde cardioplegia necessary?
HINT: 2 likely scenarios
aortic insufficiency
severe left main disease
Why must you observe face and eyes after initiation of bypass?
check for proper venous drainage
In the abscense of carotid vascular disease and chronic renal insufficiency, what is adequate MAP during the cold of phase of bypass?
40 - 80
What is the normal heparin dose for off-pump CABG?
Dose range
100 - 200 U/kg
or 2/3 rds heparin dose
What MAP/ perfusion pressure goal should you be aiming for with on pump LIMA-LAD anastamosis?
range
MAP 70 - 80
What is your first step to treat hypotension when apical suction device is applied to the heart?
Trendelenburg position
What should your MAP be less than for aortotomy?
For SVG for example?
< 90 - 100
What is important to avoid, if you can, before LIMA-LAD graft is complete during off-pump CABG?
Ie. what medication?
epinephrine gtt
How often is cardioplegia given during on-pump CABG?
approximately . . .
every 20 minutes
What is the ideal K+ level when coming off bypass/ cross clamp on the aorta removed (during on-pump CABG for example)?
Range
4.0 - 5.0
It is up to the surgeon, but what amount of Joules directly to the mycardium will they defibrillate the heart with when coming off bypass?
Range
5 - 50 Joules
When de-airing after coming off of bypass, what can by done to displace air trapped in the pulmonary veins?
maneuver
Valsalva maneuver
When should you (ideally) start inotropes after coming off of bypass?
after the aortic cross clamp is off
avoid MAP increase that could result in aortic dissection or dislodging the partial clamp!!!
During post-bypass electrocautery (ie. during sternotomy closure, if the patient is being paced what setting may you need to consider?
DOO
or asyncronous mode
How much protamine neutralizes 1 mL of heparin (ie. 1000 U of heparin)?
1 mL (or 10 mg) of protamine
If you need to go back on bypass, what do you do?
How much heparin do you give?
300 U/kg (again) [and check an ACT]
What lab could you check in order to investigate post-bypass bleeding?
But not TEG, ACT, plt . . . a different one . . .
fibrinogen
What will cardiovascular abnormality will most likely lead to hemodynamic instability with chest closure post bypass?
hypovolemia
What medication could you consider bolusing prior to coming off bypass if EF <30%?
milrinone
?dobutamine?
