1) inc. vulnerability to VF

2) Alteration in conduction pathways

This condition caused by Cardiopulmonary Bypass is usually d/t activation of the compliment cascade and inflammatory system in response to hemodilution, lung hypoxia, and increases in PA pressures-

what condition is this?

1) Congestive Edema

2) hemorrhagic atelectasis

True or False

VQ mismatching is A- Okay with CPB.

What approaches have been used to improve atelectasis as a result of putting a pt. on CPB?

Do all of these approaches work?

1) PPV

2) Intermittent Sigh breaths

3) CPAP

(None of the above have demonstrated reliable improvement)

4) Filtration of microemboli

5) Steroids

1) What it the primary post operative neuro complication r/t CPB?

2) ________ patients demonstrate some neuro deficit after CBP.

1) Stroke

2) 50%

1) Autoregulation of da brain occures between what MAP?

2) What is brain perfusion when autoregulation is intact?

3) What happens if autoregulation is lost?

1) 50-150

2) 50ml/100gm/min

3) Global ishemia occurs.

1) catecholamine levels rise significantly as time on CPB increases (thereby jacking up glucose levels)

2) At the same time cells may even become resistant to exogenous insulin.

It is sacraficed!!!!!  Aaahhhhhhhhhhhhh!!!!

Ischemic bowel leaks- and this my friends (I have been told) is not good.

1) Renal impact of the CPB is dependent on what?

2) Pump times > _______ hours are associated with high incedences of post operative renal complications

1) Length of time on the pump.

2) 3 Hours

Besides pump time, what are some other reasons or factors that can lead to renal failure during heart surgery?

(Gayle listed 6)

1) Type of procedure

2) Cardiac output (before and after)

3) Use of vasopressors

4) Acute MI

5) Massive transfusion

6) Use of IABP

In regards to Post CPB:

1) What are normal creatinine levels?

2) What creatinine level is considered abnormal? 

3) What creatinine level is considered failure?

1) 1.8 mg/100 mg or less

2) 1.9 - 5 mg/100 ml is abnormal

3) 5 mg/100 ml is considered failure

Fill in the blanks:

Preoperative creatinine levels are ____(1)______ proportional to post operative mortality and renal failure and ______(2)________ related to cardiac index.

1) Directly

2) Inversely

More on the impact of CPB:

1) What does hypothermia do to renal blood flow?

2) What results in an adequate urine output during a pump run?

3) What is the target urine output?

1) reduces  it

2) maintaining hemodilution, using mannitol in the priming solution, and maintaining GFR results in adequate urine output during a pump run. 

3) 1 ml/kg/hr

True or False:

1) The progressive rise in catecholamines during CPB contibutes to the rise in serum glucose.

2) Hyperglycemia is protective of renal tubules during CPB.

3) ADH is released during CPB

1) True

2) False- hyperglycemia is detrimental to renal tubules

3) True

1) reduction in atrial pressure (decrease in preload)

2) hypotension

3) loss of pulsatile flow

It is important for the kidney to rid the body of free water and potassium.

When are electrolytes checked?

1) What coagulation tests will show prolongation with hypothermia resulting from CPB?

2) Platelets are non-functional by ______ degrees C.

3) What happens to potassium with hypothermia induced by CPB?

1) ACT, PT, PTT

2) 28 degrees C.

3) Cellular uptake increases resulting in hypokalemia