Ingredients Sterile field – gown, gloves, swabs, drapes, povidone-iodine, wound kit with scissors, scalpel, forceps, swab clamp Local anaesthetic – syringe, large needle, small needle, LA agent Balloon – introducer needle, 11 scalpel, guide-wire, dilator(s), balloon Pressure trace – pressurised hepsal bag, long connector Pump – connector Securing – #1 suture, swabs, adherent dressing …
Category Archives: Syllabus
CPB strategy Heparin Expose the heart. Check BP/Aorta. Aortic cannulation; check cannula for pressure/flow Atrial cannulation; venous clamp off; on bypass. Lungs off Inspect the heart. Place aortic/retrograde cardioplegia. Reduce pump flow/cross-clamp aorta. Return to normal flow/check line pressure. Begin cardioplegia. Set patient temperature. Release aortic cross-clamp after warm cardioplegia. Be certain six conditions reviewed…
Preparing for bypass Before the operation Ensure cross-matched blood available for perfusionist, to prime pump if needed, for cardioplegia, for blood loss. Check imaging, planned procedure for anatomy that could complicate cannulation. Aortic: e.g. calcification/plaques, porcelain aorta, aneurysms, number of proximal graft anastomoses, aortic aneurysm/dissection surgery, Venous: type of venous cannulation (bicaval or atrial) Ensure…
Thermoregulation Input: Peripherally, cutaneous cold receptors (unmyelinated C fibres, thinly-myelinated A-delta) – DRG – to posterolateral tract (Lissauer) for 1 or 2 segments up to 2nd order neurons –> 2ON decussate and travel up spinothalamic tract to ventral posterior lateral thalamus. Processor: hypothalamus; Locus coeruleus, nuclear raphe magnus pons, pre-optic anterior hypothalamus Output: sympathetic, endocrine, behavioural, extra-pyramidal …
Isolated rib fractures Most common chest wall injury (others include sternum and clavicle) Clinical diagnosis mainly. Can use CXR to check for lung injury but may not be able to see fractures/all ribs. Can have underlying lung injury resulting in pneumothorax, haemothorax, pulmonary contusion. Management is mainly pain control – paracetamol/NSAIDS/opioids. Or use epidural, intercostal…
Indications Beat-to-beat monitoring required in patients: on vasoactive drugs (e.g. inotropes) blood pressure control prone to rapid change in condition requiring frequent blood sampling extremely hypotensive or arrythmias pulse contour analysis Method Hydraulic coupling – blood vessel connected with incompressible column of fluid that oscillates with changes in pressure (i.e. hydraulic coupling). Tranduction – converting pressure…
Most common adult congenital lesion. More common in women. Classical Types Ostium Primum – 15%; assoc with Mitral regurg, cleft anterior mitral leaflet. Large. Ostium Secondum – 65%; assoc with Mitral regurg in elderly; isolated Sinus venosus – 15%; superior (right PV and SVC mixing; common) or inferior (rare) type. assoc with p/tAPVC which may…
Methods of Myocardial Protection Myocardium need vs. Surgical demand! Surgeon wants: rapid induction, maintenance and easy reversal of cardiac arrest relaxed heart to allow for mobilization and traction a preferably bloodless and unobscured field sufficient time for adequate correction of cardiac or coronary defects Achieved by: Diastolic arrest + minimal coronary perfusion with blood +…
Intraoperative Cell Salvage (ICS) is a technique used to recover and re-infuse red blood cells during and after surgery, to reduce transfusion requirements of the patient. It removes non-cellular matter by centrifugation commonly or a counter-current system. It receives blood from: Suction – use large-bore suction tip (>4mm; e.g. Yankauer), avoid surface skimming and set vacuum…
Mechanism Roller pump at low RPM with gravity/siphoning principle Without roller-pump gravity-only circuit. Indications Reduce distension: blood leakage into heart during CPB causes distension àincreases O2 demand + impairs subendocardial perfusion Bloodless field Reduce myocardial rewarming Prevent ejection of air Usually only left heart is vented as right is vented by venous cannulae. Causes of…