Pre-op Management
STS
Postop Complications
Recovery
Potpourri
100

NSTEMI management

Heparin gtt

Double Product Control

ASA

Morphine

Oxygen

100

What STS stands for

Society of Thoracic Surgeons

100

Most common arrhythmia postoperatively and what postoperative days are most susceptible

Atrial Fibrillation

POD#2-3

100

5 sources of postoperative fever (>38.5)

Wind

Water

Walking

Wound

Wonder drugs

100

Platelet counts go (up / down / no change) postoperatively and why.

Platelet activation >> sticks to circuit

Damage and elimination by spleen

Hemodilution

Decrease in surface receptors: GP1B, GP2b-3a

200

Percentage of coronary vessel required for surgical bypass

70%

50% (LM)

200

Percent mortality for average CABG

1-2%

200

Type of Myocardial Infarction related to postoperative CABG

5

cTN >10× 99th percentile URL in the first 48 hours with either: (a) new pathological Q waves or new LBBB, or (b) angiographic occlusion, or (c) WMA

200

Describe sternal precautions

No lifting >10#

No raising objects over head

Keep elbows at the side of chest

Splint for cough/sneeze

200

Treatment of choice for postoperative Atrial Fibrillation and give appropriate doses

Beta-blocker

Amiodarone (gtt and oral load)


300

Typical Cardiac Surgery Workup (Hint: there's a lot!)

Chemistry: bmp/cbc/coags/lfts/tsh/hgba1c/ua/t&c

Imaging: TTE/TEE/carotids/cxr/ct chest

Extra: PFTs/dental


300

Number of Variables that can be inputted on the STS Online Risk Calculator

68

300

70yoM with STEMI undergoes emergent CABG for dissection of LAD during stent where a LIMA was placed. Postop he is having numerous PVCs, ~20/min. HDS on norepinephrine. What is the medication of choice for ventricular arrhythmia.

Lidocaine gtt

Amiodarone gtt

300

Cardiac rehab duration and start date after cardiac surgery

Class I indication

8-12 weeks duration (twice / week)

4 weeks after surgery

300

Plavix usage before 5 days of washout leads to increased CABG mortality.

False

400

Device used for 80% LM stenosis in a patient with 35% EF and mild angina

IABP

400

Name 4 of the 9 calculations obtained from the Online Risk Calculator (i.e. Mortality %)

Risk of Mortality

Renal Failure

Permanent Stroke

Prolonged Ventilation

DSW Infection

Re-operation

Morbidity or Mortality

Short Length of Stay

Long Length of Stay

400

82yoM undergoes TAVR for Aortic Stenosis. Postoperatively, he is slow to arouse but coherent. Later that night his speech is slurred and left grip is weaker. What is the most common etiology, arterial distribution affected and how do you manage.

Embolic - valve, aorta, CPB, hypotension

M2

Code Stroke, CTH, CTA H/N, Neurointerventionalist. Supportive Care

400

You're seeing LTC Smith for his first visit after his 3vCABG ~3 weeks postop. What are the five main things you need to accomplish during your visit.

Review vitals

Medication update

CXR

Cardiac rehab

Encouragement/Show you care...

400

Three items mandatory for discharge after cardiac surgery for CABG (one more for EF<30%)

BB

ASA

STATIN

(ACE-i)

500

Medication held due to concern for postoperative vasoplegia

ACE-i

ARB

500

Name 5 variables that significantly increase risk for surgery

Age

LVEF 

Prior Stroke

IDDM

CKD

500

64yoM undergoes aortic root replacement/hemiarch under DHCA. Postop, he is on Epi 2/NE 5/vaso 0.02. CT output for first 4 hours: 200/100/150/20. RN is on 4th bottle of 250ml 5% albumin. RN calls due to CI dropping to 1.5 despite increases in Epi, now at 8.  CVP 20, PAP 35/25. What is the likely cause.

Tamponade

500

Postoperative Day that patients are walking around ICU after cardiac surgery

One!

500

CXR shows elevated R hemidiaphragm on CXR on the morning of POD#1. Wasn't noticed on immediate postoperative CXR when intubated in the ICU. What is the etiology of a finding.

1. Right phrenic injury during LIMA takedown

2. Right phrenic injury during creation of pericardial slit for LIMA

3. Freezing of nerve after topical slush applied to heart during CABG

All of the above are possible etiologies!