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Flashcards in Group Projects Deck (26):
1

Antiphospholipid syndrome/hughes syndrome:
most common cardiac manifestations (5)

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

2

Antiphospholipid syndrome/hughes syndrome:
Pharmaceutical therapies:

1. antiplatelet and anticoagulation therapy combined
2. Warfarin with monitoring of INR (2-3)

3

Antiphospholipid syndrome/hughes syndrome:
APS patients are at risk for thrombosis so anticoagulation is imperative- what should you do

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

4

Antiphospholipid syndrome/hughes syndrome:
if patients test positive for antiphospholipid antibodies, what should they do?

take aspirin due to risk of thrombosis

5

Neonates and Premies:
causes of neonatal bleeding (4)

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

6

Gravid Patient:
maternal BP is the most important determinant of what

uterine BF and fetal oxygenation

7

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

3rd

8

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

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

9

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

avoided
useful

10

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

contact system
Intrinsic coagulation
Extrinsic coagulation
Fibrinolysis

11

Vasoplegic Syndrome:
treatment

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

12

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

methylene blue

13

Vasoplegic Syndrome:
what can you do during the case if you suspect this

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

14

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

use saline instead of normal prime (add bicarb)
RAP and VAP to prevent hemodiltion

15

Renal insufficiency:
avoid what drugs

lepirudin
bivalirudin
warfarin
Nipride
Clonidine
Phentolamine

16

Liver Failure:
what 2 things do you have to consider

impaired production of clotting factors
impairment of detoxification functions

17

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

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

18

HIPEC:
whats the duration

90 min

19

NSAIDS:
name the selective NSAID

Celecoxin (Celebrex)

20

NSAIDS:
MOA

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

21

Lipid Dyscrasias:
total cholesterol formula

LCL-C + VLDL-C + HDL-C

22

Lipid Dyscrasias:
perfusion therapeutic modalities

AVOID STASIS
pre-op statin therapy
LDL apheresis

23

Anermia:
sickle cell treatment before bypass

--Pre-op blood exchange
--remove blood and separate plasma from cells and reinfuse plasma/platelets

24

Anermia:
sickle cell treatment during bypass

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

25

Respiratory;
EVLP circuit usually contains

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

26

Respiratory:
where is the lung cannulated

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