Exam 3: CABG, pump, vascular, pacemakers Flashcards
(221 cards)
1
Q
what does the first letter of a pacemaker code refer to
A
chambers paced
2
Q
what does the second letter of a pacemaker code refer to
A
chambers sensed
3
Q
what does the third letter of a pacemaker code refer to
A
response to sensing
4
Q
what is AAI pacemaker
A
atrium paced
atrium sensed
inhibit (demand mode)
5
Q
what is VVD pacemaker
A
ventricle paced
ventricle sensed
dual (dependent)
6
Q
what kind of heart rhythms use inhibit mode on pacemaders
A
fast
AFIB with RVR
7
Q
what kind of heart rhythms use Dual mode on pacemaker
A
blocks
8
Q
what is DDD pacemaker
A
dual paced
dual sensed
dual (dependent)
9
Q
what does a magnet do to a pacemaker
A
VOO for single chamber
DOO for dual chamber
pacing on
sensing off
response off
10
Q
what part of the ECPP is a holding tank/filter/defoamer for blood
A
venous reservoir
11
Q
what part of the ECPP provides mechanical oxygenation/ventilation
A
oxygenator
12
Q
what part of the ECPP cools/warms blood
A
heat exchanger
13
Q
what part of the ECPP supplies medical air/FiO2 to oxygenator
A
Blender
14
Q
what part of the ECPP pumps blood
A
Arterial pump
15
Q
what part of the ECPP scavenges blood from surgical field/vents heart (prevents excess blood loss/poor surgical field of view)
A
cardiotomy suction/vent lines
16
Q
what part of the ECPP allows for myocardial arrest
A
Cardioplegia System
17
Q
what part of the ECPP supplies anesthetic gas to oxygenator
A
Vaporizer
18
Q
what part of the ECPP Bridges the HLM to the patient
A
Cannulae
19
Q
what is normal dose for Heparin
A
300-400 units/kg
20
Q
what is the half life of Heparin
A
2.5 hours
21
Q
what does heparin bind to
A
antithrombin 3
22
Q
what clotting factors does heparin inactivate
A
2a
9a
10a
11a
12a
23
Q
what is ACT goal for CPB
A
480 seconds
24
Q
what is ACT goal for TAVRs
A
250-300 seconds
25
what is antidote dose for heparin
1-1.3 mg/100 heparin
26
what deficiency leads to heparin resistance
antithrombin 3 deficiency
27
what is treatment for AT3 deficiency
FFP
28
if patient has heparin resistance, what two medications can we use for anticoagulation
bivalrudin
argatroban
29
what is the MOA of bivalrudin
direct thrombin inhibitor
30
what is the dose for bivalrudin for CPB
1mg/kg bolus
2.5 mg/kg/hr infusion
31
what labs do we monitor for bivalrudin
ACT
aPTT
32
your patient has heparin resistance and renal failure, what anticoagulant do you use
argatroban
33
your patient has heparin resistance and liver failure, what anticoagulant do you use
bivalrudin
34
what is the moa of argatroban
direct thrombin inhibitor
35
what labs do we monitor with argatroban
ACT
aPTT
36
what anticoagulant do we use for patients with HIT
argatroban
37
what is the half life of argatroban
45-55 min
38
what is the half life of bivalrudin
25 min
39
what is the MOA of amicar/aminocaproic acid
Aminocaproic acid is a lysine analog that binds competitively to plasminogen, blocking plasminogen from binding to fibrin and the subsequent conversion to plasmin
This activity subsequently results in the inhibition of fibrin degradation (fibrinolysis)
40
what is the MOA of TXA (tranexamic acid)
-lysine analog that inhibits plasminogen activation
-synthetic plasminogen-activator, inhibition of fibrinolysis and clot degradation
41
formula for calculating CPB HCT
(preop hct x pt blood volume) / (patient blood volume+ prime volume + anesthesia volume)
42
SVR calculation
MAP-CVP/CO x 80
43
for every 7* drop in temp, VO2 is reduced by ____________
50%
44
what is mild hypothermia for CPB
34-36
45
what is moderate hypothermia for CPB
28-33
46
what is severe hypothermia for CPB
22-27
47
what is deep hypothermia for CPB
21
48
what is glucose goal post CPB
<180
49
where does antegrade cardioplegia go
coronary arteries
drains out of coronary sinus/RA
50
where does retrograde cardioplegia go
coronary sinus
drains out of coronary arteries
monitored via coronary sinus pressure
51
what two labs often increase on rewarming
K
glucose
52
how many chambers
2
53
how many chambers
1
54
how many chambers
1
55
what kind of pacemaker
dual chamber AICD
56
what kind of pacemaker
single chamber AICD
57
what kind of pacemaker
biventricular pacemaker
58
what kind of device
leadless pacemaker
59
what is this device
loop recorder
60
what happens with collateral myocardial circulation and CAD
increase in size and number
61
T/F collateral myocardial circulation exists in normal hearts
true
62
T/F collateral myocardial circulation is beneficial at rest
true
63
what can happen with collateral myocardial circulation during increased myocardial demand
coronary steal
64
Coronary steal graphic
65
what is an anastomosis
a connection made between 2 vessels
66
what does the # of grafts refer to
the number of DISTAL anastomosis made
67
what do we do PREOP for CABG
*Beta-blocker administration within 24 hrs. of procedure
*All should receive statin
*Continuation of calcium channel blockers
*ACE inhibitor continuation is controversial - I prefer holding
*ASA continue or hold 6-24 hrs. pre-op
*Antiplatelet is typically held 5-7 days
*Heparin usually discontinued in pre-op 1 hour prior
*Typically metformin held 24-48 hrs. pre-op
68
T/F give BB prior to CABG
true
69
T/F give statin before CABG
T, to all patients
70
T/F continue CCB before CABG
true
71
T/F continue ACE-I before CABG
false
72
T/F continue ASA before CABG
either continue or hold for 6-24 hours
73
T/F continue anti-platelet therapy before CABG
F, hold for 5-7 days
74
T/F continue heparin before CABG
F, D/C 1 hour prior
75
T/F continue metformin before CABG
F, hold for 24-48 hours
76
what do CRNAs do PREOP for CABG
large bore IV placement
A-line placement
CVL or CORDIS placement
anxiolytics
77
what intraop monitors do we use for CABG
A line
CVP
PA
CO/CI
TEE
SvO2
TEG
78
what drugs do we have prepped for induction of CABG
INDUCTION
-lidocaine
-fentanyl/sufentanil
-etomidate
-roc/vec/cis
UPPERS
neo stick
levophed on pump
epinephrine on pump
DOWNERS
nitroglycerin
79
what occurs post induction for CABG
line placement and TEE
80
what lab monitors clot formation and breakdown graphically
TEG- thromboelastography
81
what does R value of TEG tell us
time for initial clot/fibrin formation
82
what does K value of TEG tell us
speed of clot formation at the end of R until amplitude reaches 20 mm
83
what does the Alpha Angle of TEG tell us
Speed of clot formation like K. Both are speed of clot strengthening
84
what does MA of TEG tell us
Strength of clot based on platelet function, fibrin, and interaction between platelets and polymerizing fibrin. (Maximum Amplitude) of clot. Maximum strength of clot
85
TEG picture
86
what is the most controllable and important determinant of myocardial oxygen consumption
HR
87
what is formula for coronary perfusion pressure
Diastolic BP-PCWP
88
what is goal of intraop BP maintanence for CABG
maintain adequete coronary perfusion pressure
89
what is hemodynamic goal for preload for CABG
decrease
(decreased LVEDP will increase myocardial O2 supply and decrease demand. Nitroglycerin selectively dilates coronary vessels)
90
what drug selectively dilates coronary vessels
nitroglycerin
91
what is goal for HR for CABG
slow/normal
(too fast=ischemia, consider BB)
(too slow= not enough CO for coronary perfusion)
92
what medication can we give during CABG if HR is too fast
B-BLocker
93
what can too fast of a HR during CABG lead to
ischemia
94
what can too slow of a HR during CABG lead to
decreased coronary perfusion
95
what is goal for rhythm for CABG
maintain Sinus
(maintains 20% atrial kick for CO)
96
what is goal for compliance during CABG
increase
(concentric LCH common with HTN history decreases compliance)
97
what cardiac change can HTN lead to
concentric LVH
98
what is goal for contractility in CABG if normal LVF
depress
(decreased contractility= decreased MVO2)
99
what is goal for contractility in CABG if decreased LVF
support
100
what does a decrease in contractility lead to
decreased myocardial use of O2 (MVO2)
101
what is goal of SVR for CABG
maintain
(hypertension is better than hypotension)
102
what do we treat hypotension with in CABG
phenylephrine
103
what is goal of PVR for CABG
maintain
(usually not a problem)
104
what are sights for graft harvesting with CABG
saphenous vein
radial artery
LIMA/RIMA
105
which graft has longer patency
LIMA/RIMA
106
GRAFT type graphics
107
what is an important anesthesia action during sternotomy
'OFF LUNGS"
hold ventilations, switch to manual
108
what is an anesthetic consideration during LIMA harvest
keep low TV to prevent obstructing surgeons view
109
what occurs in CABG after sternotomy/LIMA harvest
aortic cannulation
110
what is target ACT for CABG/PUMP
480 sec
111
what is minimum ACT for pump
400
112
what is bolus dose of CABG for initial heparization
300-400 units/kg
113
what is off pump dose of heparin for CABG
1/2 pump dose (150-200units/kg)
114
when do we give heparin bolus for CABG
prior to the LIMA/RIMA takedown
115
what is BP goal for aortic cannulation
BP <90 sys
116
when can we allow BP to rise
after cannula is placed
117
what do we monitor during CABG
*Monitor electrolytes
*Monitor glucose
*Monitor MAP
*Monitor cerebral oximeter
*Ensure anesthetic is being delivered (perfusionist)
*Meds upon warming
118
what do we do when preparing to come off pump
resume ventilation
prepare to receive circuit volume
119
how can we prepare to receive circuit volume when coming off pump
*Make room by decreasing SVR
*Maintain MAP of 60-70
*Monitor right heart via swan and surgeon's eyes
*TEE to assess LV function
*Add inotrope support if necessary
*Ask perfusion to spin down the rest for later administration
120
what is BP goal for aortic decannulation
systolic BP <90
121
what is dose of protamine for reversal of heparin
1 mg per 100u heparin
122
when do we give protamine
after decannulation has occurred
123
what kind of line do we give protamine in
peripheral IV
124
what do we give to 'pretreat" for histamine reaction
antihistamine
H2 agonist such as famotidine
125
what is a consideration for protamine administration
give slow
126
what are S/S protamine reaction
increase PiP
decreased BP
127
when do we get ACT after protamine admin
5 min
128
what may happen that could require more protamine
cell savor blood is given (still hepranized)
129
what is HCT goal post op
22-25%
130
what is EF requirement for OPCABG
>30%
131
what hemodynamic change do we prepare for in OPCABG
extreme swings in BP
132
what medications do we prepare to combat OPCABG BP swings
albumin 500 ml 5%
nitro
levo
133
what is it called when they lift the heart up out of the chest during OPCABG
verticalization of heart
134
exposure for the __________ is considered with the most dramatic deterioration in stroke volume
circumflex
135
what are features of noncompliant LV (LVH)
compromised diastolic filling
dependence on atrial kick
136
how is LVEDP in concentric hypertrophy
maintained
137
what is C
TV
138
what is D
RA
139
what is E
LV
140
what is F
MV
141
what is G
LA
142
what is A
RV
143
what is B
TV
144
what is C
RA
145
what is D
LV
146
what is E
MV
147
what is F
LA
148
what view is this
Subcostal 4 chamber view
149
what view is this
subcostal IVC view
150
what is A
diaphragm
151
what is B
hepatic vein
152
what is C
RA
153
what is D
IVC
154
what is E
Liver
155
what view is this
apical 4 chamber view
156
what is A
apex of heart
157
what is B
LV
158
What is C
AV
159
what is D
MV
160
what is E
LA
161
What is F
RV
162
what is G
TV
163
what is H
RA
164
what view is this
PLAX
165
what is A
RV
166
what is B
aortic outflow
167
what is C
AV
168
what id D
LV outflow
169
what is E
LV
170
what is F
MV
171
what is G
LA
172
what view is this
PSAX
173
what is A
RV
174
What is B
LV
175
what is C
papillary muscles
176
5 Ps of limb ischemia
Pulselessness -early sign
Pallor-early sign
pain
Parathesia-late sign
paralysis-late sign
177
what ABI ratio is abnormal
<0.9
178
what ABI ratio is associated with limb threatening ischemia
<0.4
179
Type 1 crawford aneurysm
all or most of the descending thoracic aorta
and the upper abdominal aorta
180
crawford type II aneurysm
involve all or most of the descending thoracic aorta and all or most of the abdominal aorta
181
type III crawford
involve the lower portion of the descending thoracic aorta and most of the abdominal aorta
182
type IV crawford
involve all or most of the abdominal aorta, including the visceral segment.
183
type 1 debakey
begin in the ascending aorta and extend throughout the entire aorta.
184
type II debakey
confined to the ascending aorta
185
type III debakey
begin just distal to the left subclavian artery and extend either to the diaphragm(type IIIA) or to the aortoiliac bifurcation (type IIIb).
186
stanford type A
involve the ascending aorta
187
standford type B
do not involve the ascending aorta
188
crawford type I
189
crawford type 2
190
crawford type 3
191
crawford type 4
192
low clotting factor function
193
low platelet function
194
low fibrinogen level
195
low clotting factors
low platelet function
196
platelet hypercoagulability
197
enzymatic hypercoagulability
198
platelet and enzymatic hypercoagulability
199
primary fibrinolysis
200
secondary fibrinolysis
201
R on teg
clotting time
looks at coagulation pathways
thrombin generation and fibrin formation
202
alpha angle and K time on teg
coagulation pathway and platelets
fibrin X linking
fibring <-->platelet
203
MA on TEG
maximum clot strength
platelet-fibrin/fibrinogen interactions
platelets (~80%)
fibrin/fibrinogen (~20%)
204
end of MA on teg
clot stability
reduction in clot strength
fibrinolysis
205
What do you see on hypo coagulable TEG
increased R time
Increased K time
decreased alpha angle
decreased MA
206
what do you see of hyper coag TEG
decreased R time
Decreased K time
increased alpha angle
increased MA
207
what factors are absent in rbc
Factor V
Factor VIII
208
what is not present in ffp
platelets
209
which coagulation factors are in ffp
all of them except platelets
210
what blood product is given for hemophilia A
cryoprecipitate
211
what factors are in cryoprecipitate
1
8
13
vWF
Protein C
212
what blood product is given for hypofibrinogenemia
cryoprecipitate
213
what clotting factors need vitamin K
prothrombin,
7,
9,
10,
protein s, c, and z
214
Define atherosclerosis
Fatty material or plaques form on the inner walls of the coronary arteries and restrict flow
A specific form of arteriosclerosis
215
Define arteriosclerosis
Disease process where coronary arteries narrow and harden
216
TEG/ACT> 140
FFP
217
R time > 10
FFP
218
K time > 3
Cryo
219
Alpha angle < 53
Cryo and platelets
220
MA < 50
Platelets
221
LY30 > 30%
Txa
