Defects & Pediatric Perfusion: Topic 2 Flashcards Preview

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Flashcards in Defects & Pediatric Perfusion: Topic 2 Deck (66):
1

How old is considered "Neonatal"?

<30 days

2

How old is considered "Pediatric"?

Up to 18 yo (<18)

3

What is the primary energy source for peds?

Glucose

4

What is the primary energy source for adults?

Fatty acids

5

When do neonates myocardium mature?

3-12 months

6

What is immature myocardium prone to?

Stretch injury

7

Weight: <10 kg Volume: ?

85 cc/kg

8

Weight: 11-20 kg Volume: ?

80 cc/kg

9

Weight: 21-30 kg Volume: ?

75 cc/kg

10

Weight: 31-40 kg Volume: ?

70 cc/kg

11

Weight: > 40 kg Volume?

65 cc/kg

12

What weight is considered an adult?

>40 kg

13

What size are Neonatal Packs?

3/16'' x 1/4''

14

What size are infant packs?

1/4'' x 1/4''

15

What size are pediatric packs?

1/4'' x 3/8''

16

What size are small adult packs?

3/8'' x 3/8''

17

What size are adult packs?

3/8'' x 1/2''

18

Normothermic Flow Weight 0-3 kg

200 cc/kg

19

Normothermic Flow Weight 3-10

150 cc/kg

20

Normothermic Flow Weight 10-15 kg

125 cc/kg

21

Normothermic Flow WEight 15-30 kg

100 cc/kg

22

Normothermic Flow Weight >30 kg

75 cc/kg

23

Normothermic Flow Weight >55 kg

65 cc/kg

24

Some hospitals will index peds flows @ ____m^2 up to ______ m^2

2.4 m2 up to 3.2m2

25

What is the SV/rev in a 3/16'' boot diameter?

7 cc

26

Do not exceed ______ rpms for max tubing flows?

100 rpms

27

Look for _____ flow- ______ pressure drops.

High, low

28

What is the max flow and the prime volume of the Terumo Baby RX05

1.5 L/min 43 ccs

29

Basic Prime Constituents: Adults

Mannitol NaHCO3 Albumin/Hetastarch Normosol Antibiotic Heparin 10 K units

30

Basic Prime Constituents: Pediatrics

Mannitol 25% Albumin CaCl2 Solumedrol Packed RBCs NaHCO3 Normosol Antibiotic Heparin 100 units

31

25% Albumin

Large molecule Aids passification of tubing Elevates COP and serum osmolarity Good osmotic "pull" from tissues (1.3:1) Be careful in recommendations

32

What does X-coating call for?

Wetting with crystalloid first

33

What antibiotic is titrated during CPB?

Vancomycin

34

Name the common antibiotics used on bypass.

Cefazolin (Kefzol, Ancef) Ampicillin Gentamicin Nafcillin Vancomycin

35

Cefazolin (Kefzol, Ancef) Dose

25 mg/kg (max dose = 1 g)

36

Ampicillin Dose

50 mg/kg (max dose = 1g)

37

Gentamicin Dose

2 mg/kg (max dose= 80 mg)

38

Nafcillin Dose

25 mg/kg (max dose= 1g)

39

Vancomycin Dose

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

40

Solumedrol (Methylprednisolone) Dose; What two times is it given?

30 mg/kg (up to 500mg) in prime and in peds when aoritc xc is released

41

NaHCO3 Prime Concentration

24 mEq/L

42

How to calculate amt of NaHCO3 necessary for a given amount of asanguinous volume?

mEq NaHCO3 = 0.025 (ml asanguinous vol) x = 0.025 V

43

If PRBCs are added to the prime, NaHCO3 dose should be calculated using what formula?

mEq NaHCO3 = 0.3 (kg wt) (BE)

44

Mannitol

Osmotic Diuretic Elevates Osmolarity rapidly Given over a range of medical disciplines Oxygen radical scavenger

45

Mannitol Dose in the prime; when is it given?

0.25 g/ kg in the prime; an additional 0.25 g/kg is administered upon release of the XC

46

Mannitol is what percent solution?

25%

47

What should be measured shortly after the initiation of CPB?

Ionized Ca++ level of the perfusate

48

What should ionized Ca++ level of the perfusate be corrected up to? Why?

0.7- 0.8 mM/L; this would allow the appropriate level to be present in the cardioplegia solution of a standard 4:1 solution

49

For neonates/infants, how much PRBCs should be added to the prime? Why?

Neonates/infants <5kg, 100 ml PRBCs are added to the prime to avoid a prolonged period of asanguinous perfusion

50

Pediatric Monitoring Devices: Common equipment in the pediatric OR

ACT TEG Hepcon HMS Platelet Works NIRS CDI Blood gas analyzer

51

What has higher ACT readings: Hemochron or the Hepcon

Hemochron has higher ACT readings; hepcon has lower readings

52

TEG

Sporatic use in OR/Perfusion Labs Takes a long time to finalize looks at the larger spectrum

53

TEG uses a __________ test on whole blood.

Viscoelastic test

54

Viscoelastic

Measures both elastic and viscous behavior

55

How often does TEG rotate the specimen in the cuvette?

Every 10 seconds

56

Platelet Works

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

57

NIRS

Near-infrared spectroscopy (NIRS), such as that used in pulse oximetry has been used and trusted in the world of medicine for decades Spectroscopic method uses near-infrared region of the electromagnetic spectrum

58

What spectrum does NIRS use?

800 nm to 2500 nm

59

CDI In-line Analyzer

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

60

Normal TEG

61

Anticoagulants/ Hemophilia TEG

62

Platelet Blockers (TEG)

63

Fibrinolysis (TEG)

64

Hypercoagulation (TEG)

65

DIC: Stage 1 (TEG)

66

DIC: Stage 2 (TEG)