Cardiothoracic ICU

Rhythm and Blues

100

Most common arrhythmia with Swan placement

PVC

200

Most common cardiac arrhythmia that typically arises on POD2/3

Atrial fibrillation

300

Lidocaine suppresses this dangerous arrhythmia

Ventricular Tachycardia

400

Electrical concern following valvular surgeries

Complete Heart Block

1^o - Prolonged PR

2^o - Mobitz 1/2

3^o - CHB

500

Causes of Tachycardia in the Postop CT patient

Pain, Bleeding, Hypovolemia, Atrial Fibrillation, BetaBlocker withdrawal, Pulmonary embolism, ETOH withdrawal, others...

Stop looking at me Swan!

100

Name the method by which Cardiac Output is determined

Thermodilution

200

Name at least 3 Complications in placing a Swan

Arrhythmia

PTX

PA rupture/Hemothorax

Infection

300

Depth at which most Swans are placed

~50cm

400

Normal Cardiac Index

>2.2 LPM/m²

500

What pressure finding confirms catheter successfully floated inside pulmonary artery?

Elevation of diastolic pressure

Drip Drop

100

Chemical secreted by posterior pituitary that aids in water retention and smooth muscle constriction

Vasopressin

200

T

300

Primary action of Dopamine based on dosage...

1. low dose (<5mcg/kg/min)- D1/2 receptors

3. medium dose (5-15mcg/kg/min) - Beta

3. high dose (>15mcg/kg/min) - Alpha

400

Electrolyte mainly responsible for increasing contractility

Calcium

(treat when <1mmol/L)

500

Phosphodiesterase Inhibitor that acts as an Inotrope and vasodilator?

Milrinone

blocks one of the five subtypes of PDE which prevents the inactivation of cAMP and cGMP

Monitoring the situation

100

4 Factors that affect Cardiac Output

1. HR

2. Contractility

3. Preload

4. Afterload

200

Bedside RN calls you at 2am. What numbers on the monitor should you ask for?

HR, BP, CVP, CI, SVR, SvO2

(UOP, CT output)

300

What 2 factors cause Pulmonary Vasoconstriction 

Hypoxemia

Hypercapnia

400

The change in the amount of blood ejected from the left ventricle into the aorta with each heartbeat

SVV

(treat typically when >10-15%)

500

Most common EKG finding of Blunt Cardiac Injury

Tachycardia

What's the Story

100

62yoM s/p CABG having difficulty weaning from cardiopulmonary bypass.  HR 102, BP 86/40,  CI 1.7, CVP 16, PAP 30/18, SVR 1900. What non-pharmacologic adjunct could be used to get this patient off the table so the surgeon can make his tee-time?

IABP

200

62yoM s/p CABG 5 hours ago with HR 102, BP 86/40,  CI 1.7, CVP 20, PAP 50/30, SVR 1900. RN increased Pressor doses without improvement.

Tamponade

300

62yoM s/p CABG 5 hours ago with HR 90, BP 92/50,  CI 1.7, CVP 5, PAP 22/10, SVR 1900. RN asking for your help. Next step in management...

Fluid bolus

400

62yoM s/p CABG 5 hours ago with HR 102, BP 86/40,  CI 2.5, CVP 14, PAP 24/12, SVR 400. RN gave fluid bolus. She calls exasperated...

Alpha agent, such as norepinephrine

If persists... Methylene Blue (antagonizes NO and blocks cGMP, scavenger of free radicals)

500

62yoM with DM/HTN presented to the ER with acute onset of chest pain. He became "hypotense" and required intubation. MICU admitted him and floated a swan. VS: HR 102, BP 86/40,  CI 1.5, CVP 16, PAP 35/20, SVR 1900. RN just called and wanted to know all about cardiogenic shock. 

In 10 seconds, name as many causes of cardiogenic shock as you can... GO!

acute myocardial infarction

pulmonary embolism

myocarditis

valvular heart disease

endocarditis / sepsis

drug overdose

tamponade

blunt cardiac injury