Defects & Pediatric Perfusion: Topic 2

Question 1

How old is considered “Neonatal”?

Answer 1

<30 days

Question 2

How old is considered “Pediatric”?

Answer 2

Up to 18 yo (<18)

Question 3

What is the primary energy source for peds?

Answer 3

Glucose

Question 4

What is the primary energy source for adults?

Answer 4

Fatty acids

Question 5

When do neonates myocardium mature?

Answer 5

3-12 months

Question 6

What is immature myocardium prone to?

Answer 6

Stretch injury

Question 7

Weight: <10 kg Volume: ?

Answer 7

85 cc/kg

Question 8

Weight: 11-20 kg Volume: ?

Answer 8

80 cc/kg

Question 9

Weight: 21-30 kg Volume: ?

Answer 9

75 cc/kg

Question 10

Weight: 31-40 kg Volume: ?

Answer 10

70 cc/kg

Question 11

Weight: > 40 kg Volume?

Answer 11

65 cc/kg

Question 12

What weight is considered an adult?

Answer 12

>40 kg

Question 13

What size are Neonatal Packs?

Answer 13

3/16’’ x 1/4’’

Question 14

What size are infant packs?

Answer 14

1/4’’ x 1/4’’

Question 15

What size are pediatric packs?

Answer 15

1/4’’ x 3/8’’

Question 16

What size are small adult packs?

Answer 16

3/8’’ x 3/8’’

Question 17

What size are adult packs?

Answer 17

3/8’’ x 1/2’’

Question 18

Normothermic Flow Weight 0-3 kg

Answer 18

200 cc/kg

Question 19

Normothermic Flow Weight 3-10

Answer 19

150 cc/kg

Question 20

Normothermic Flow Weight 10-15 kg

Answer 20

125 cc/kg

Question 21

Normothermic Flow WEight 15-30 kg

Answer 21

100 cc/kg

Question 22

Normothermic Flow Weight >30 kg

Answer 22

75 cc/kg

Question 23

Normothermic Flow Weight >55 kg

Answer 23

65 cc/kg

Question 24

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

Answer 24

2.4 m2 up to 3.2m2

Question 25

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

Answer 25

7 cc

Question 26

Do not exceed ______ rpms for max tubing flows?

Answer 26

100 rpms

Question 27

Look for _____ flow- ______ pressure drops.

Answer 27

High, low

Question 28

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

Answer 28

1.5 L/min 43 ccs

Question 29

Basic Prime Constituents: Adults

Answer 29

Mannitol NaHCO3 Albumin/Hetastarch Normosol Antibiotic Heparin 10 K units

Question 30

Basic Prime Constituents: Pediatrics

Answer 30

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

Question 31

25% Albumin

Answer 31

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

Question 32

What does X-coating call for?

Answer 32

Wetting with crystalloid first

Question 33

What antibiotic is titrated during CPB?

Answer 33

Vancomycin

Question 34

Name the common antibiotics used on bypass.

Answer 34

Cefazolin (Kefzol, Ancef) Ampicillin Gentamicin Nafcillin Vancomycin

Question 35

Cefazolin (Kefzol, Ancef) Dose

Answer 35

25 mg/kg (max dose = 1 g)

Question 36

Ampicillin Dose

Answer 36

50 mg/kg (max dose = 1g)

Question 37

Gentamicin Dose

Answer 37

2 mg/kg (max dose= 80 mg)

Question 38

Nafcillin Dose

Answer 38

25 mg/kg (max dose= 1g)

Question 39

Vancomycin Dose

Answer 39

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

Question 40

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

Answer 40

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

Question 41

NaHCO3 Prime Concentration

Answer 41

24 mEq/L

Question 42

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

Answer 42

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

Question 43

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

Answer 43

mEq NaHCO3 = 0.3 (kg wt) (BE)

Question 44

Mannitol

Answer 44

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

Question 45

Mannitol Dose in the prime; when is it given?

Answer 45

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

Question 46

Mannitol is what percent solution?

Answer 46

25%

Question 47

What should be measured shortly after the initiation of CPB?

Answer 47

Ionized Ca++ level of the perfusate

Question 48

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

Answer 48

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

Question 49

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

Answer 49

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

Question 50

Pediatric Monitoring Devices: Common equipment in the pediatric OR

Answer 50

ACT TEG Hepcon HMS Platelet Works NIRS CDI Blood gas analyzer

Question 51

What has higher ACT readings: Hemochron or the Hepcon

Answer 51

Hemochron has higher ACT readings; hepcon has lower readings

Question 52

TEG

Answer 52

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

Question 53

TEG uses a __________ test on whole blood.

Answer 53

Viscoelastic test

Question 54

Viscoelastic

Answer 54

Measures both elastic and viscous behavior

Question 55

How often does TEG rotate the specimen in the cuvette?

Answer 55

Every 10 seconds

Question 56

Platelet Works

Answer 56

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

Question 57

NIRS

Answer 57

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

Question 58

What spectrum does NIRS use?

Answer 58

800 nm to 2500 nm

Question 59

CDI In-line Analyzer

Answer 59

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

Question 60

Answer 60

Normal TEG

Question 61

Answer 61

Anticoagulants/ Hemophilia TEG

Question 62

Answer 62

Platelet Blockers (TEG)

Question 63

Answer 63

Fibrinolysis (TEG)

Question 64

Answer 64

Hypercoagulation (TEG)

Question 65

Answer 65

DIC: Stage 1 (TEG)

Question 66

Answer 66

DIC: Stage 2 (TEG)