Group Projects

Question 1

Antiphospholipid syndrome/hughes syndrome:

most common cardiac manifestations (5)

Answer 1

Valvular disease (mitral)
CAD
Intracardiac thrombus formation
Pulmonary HTN
Dialted cardiomyopathy

Question 2

Antiphospholipid syndrome/hughes syndrome:

Pharmaceutical therapies:

Answer 2

1. antiplatelet and anticoagulation therapy combined

2. Warfarin with monitoring of INR (2-3)

Question 3

Antiphospholipid syndrome/hughes syndrome:

APS patients are at risk for thrombosis so anticoagulation is imperative- what should you do

Answer 3

double ACT baseline or reach 2x normal value (960+)
us other anticoagulants (lepirudin, argatroban)
—ECMO and VAD patients must be on an anticoagulant

Question 4

Antiphospholipid syndrome/hughes syndrome:

if patients test positive for antiphospholipid antibodies, what should they do?

Answer 4

take aspirin due to risk of thrombosis

Question 5

Neonates and Premies:

causes of neonatal bleeding (4)

Answer 5

thrombocytopenia 
congenital factor deficiencies (Hemophilia A or B)
aquired deficiencies (Vit-K deficiency)
disseminated intravascular coagulation

Question 6

Gravid Patient:

maternal BP is the most important determinant of what

Answer 6

uterine BF and fetal oxygenation

Question 7

Gravid Patient:

increase in hemodynamic variables (CO, Blood vol, HR, stroke rate) all increase in what trimester

Answer 7

3rd

Question 8

Gravid Patient:

do they increase or decrease: clotting factors, protein C and S, PAI-1 and PAI-2

Answer 8

Increase- clotting factors 1, 2, 7, 8, 9, 12
shows resistance- protein C
decrease- protein S
increase- PAI-1
increase- PAI-2

Question 9

Gravid Patient:
alph-adrenergic agents should be…
drugs that exhibit combination of alpha and beta acticity are the most..

Answer 9

avoided

useful

Question 10

Vasoplegic Syndrome:

plasma proteins get absoebed into a biolayer on the walls of the ECC- they display receptors and activate what pathways?

Answer 10

contact system
Intrinsic coagulation
Extrinsic coagulation
Fibrinolysis

Question 11

Vasoplegic Syndrome:

treatment

Answer 11

high doses of vasopressors post-op,
Nor-epi
dopamine
methylene blue
phenylephrine 
running hypothermia during the case

Question 12

Vasoplegic Syndrome:

what can be added to the prime in an effort to avoid this if the patient is high risk

Answer 12

methylene blue

Question 13

Vasoplegic Syndrome:

what can you do during the case if you suspect this

Answer 13

put methylene blue in the prime
don’t transfuse cardiotomy blood back to the patient
add volume
increase arterial pump flow

Question 14

Renal insufficiency:

what should you use for the prime and what do you do to prevent hemodilution

Answer 14

use saline instead of normal prime (add bicarb)

RAP and VAP to prevent hemodiltion

Question 15

Renal insufficiency:

avoid what drugs

Answer 15

lepirudin
bivalirudin
warfarin
Nipride
Clonidine
Phentolamine

Question 16

Liver Failure:

what 2 things do you have to consider

Answer 16

impaired production of clotting factors

impairment of detoxification functions

Question 17

Liver Failure:
Drugs with first pass metabolism →
Drugs with high clearance →
Drugs with low clearance →

Answer 17

first pass metabolism → reduce in oral dose
high clearance → adjust loading and maintenance doses
low clearance → adjust maintenance dose

Question 18

HIPEC:

whats the duration

Answer 18

90 min

Question 19

NSAIDS:

name the selective NSAID

Answer 19

Celecoxin (Celebrex)

Question 20

NSAIDS:

MOA

Answer 20

act locally on tissues where protaglandins are synthesized by inhibiting the cyclooxygenase pathway

Question 21

Lipid Dyscrasias:

total cholesterol formula

Answer 21

LCL-C + VLDL-C + HDL-C

Question 22

Lipid Dyscrasias:

perfusion therapeutic modalities

Answer 22

AVOID STASIS
pre-op statin therapy
LDL apheresis

Question 23

Anermia:

sickle cell treatment before bypass

Answer 23

• -Pre-op blood exchange

- -remove blood and separate plasma from cells and reinfuse plasma/platelets

Question 24

Anermia:

sickle cell treatment during bypass

Answer 24

maintain HCT above 24%
Prevent hypothermia (dont go below 33C)
Keep SvO2 over 80%
use crystalloid plegia instead of blood plegia
hemoconcentrate durin CPB

Question 25

Respiratory;

EVLP circuit usually contains

Answer 25

a reservoir, centrifugal pump, oxygenator/heat exchanger, leukocyte depleting filter and a flow meter

Question 26

Respiratory:

where is the lung cannulated

Answer 26

pulmonary artery (PA) and left atrial (LA) appendage