BE READY!
Your patient is coming out paced- what do you want to do to prep the room?
Extra pacer box
Extra batter
change monitor to paced mode
Tamponade
This surgery repairs a TGA
Switch
Interpret this arterial gas
7.28, 50, 89, 28, +1
Respiratory Acidosis
Patient is a 5 yo post op patient in complete heart block with pacing wires set to a rate of 150. Patient's heart rate has dropped drastically and you notice patient's pacing wire broke.
What do you do?
YELL for help
Assess patient's stabiliy (BP etc)
Compressions if needed
STRIP the pacing wire-
if still not working external pacing (sedate patient!)
What should be in the room of a post op patient?
Chest tube suction, ett tube/ oral suction
Chest tube clamps/ posy, chest tube safety set (gauze, vaseline gause and dressing)
Med wt sheet
Bag Mask
Extra pumps / medlines
More than 10/kg/hr
These 3 surgeries are done to repair HLHS
Hybrid
Glenn
Fontan
What does oxyHGB on venous gas show?
Mixed venous/ consumption of oxygen in the body
Should reflect/ match your NIRS!
Intubated post op patient. Desaturated to 70s from normal 100s.
Looking at ventilator patient has no tidal volumes.
What do you do?
Suction and assess ETT! What if ETT is normally at 8cm but is now at 4cm?
Is patient irritated/ holding breath? Does patient need sedation? Bag patient.
High CVP
Narrow Pulse Pressure
Tachycardia
Muffled heart sounds
What patients are at high risk for post op arrythmias?
VSD, AVC, etc
any surgery where the ventricle or asd is repaired and the electrical pathways is disturbed
What is a ross procedure?
Place a conduit for pulmonary blood flow.
What would you do to correct this gas? Patient is intubated?
7.55, 21, 70, 24, +1
Patient is post op TAPVR. Patient is irritable and starts to decompensate. Vitals are bp 50/30, hr 180, spo2 80, co2 60, cvp 24.
What is happening? What will you do?
PHTN Crisis
Bag, increase fio2, sedation, INO, sildenafil
Your patient abruptly goes into SVT... what will you do? What is the FIRST priority?
IS PATIENT STABLE OR UNSTABLE
stable- vaso vagal manuvers, adenosine
unstable- synch cardioversion
Your patient has PHTN... what is treatment of phtn crisis?
OXYGEN
Nitric
Sedation
Bagging/ etc
What are the four components of a TET?
1. VSD
2. overriding aorta
3. pulmonary valve stenosis
4. RV Hypertrophy
What is lactic acid?
Lactic acid is released when the heart is under stress, i.e. low CO, hypoxia.
Patient is 8m fresh post op.
Vitals
HR 180 CVP 25 BP 50/45 RR 60 Muffled Heart sounds JVD on assessment
What is happening? What do you do?
Tamponade
CALL FOR HELP! Surgeon called.
STRIP that CHEST TUBE!
Your post op patient's vitals read
HR 190, BP 58/36, CVP 4, SPO2 95
what are you thinking is going on with this patient?
They are probably dry!
Give volume- maybe patient needs blood?
What is LCOS?
Low cardiac output syndrome- decrease in systemic perfusion secondary to myocardiac dysfunction that occurs 9-16 hours post bypass
What is a TAPVR?
What are the types of TAPVR?
Total anomalous pulmonary venous return
Pulmonary veins drain in the wrong spot- should be in the LA!
Supracardiac veins connect to SVC via vertical vein
Infracardiac-veins drain into the RA
INfradiaphgragmatic- veins drain to IVC via vein
7.28, 45, 70, 18, -3
Bicarb and possibly make vent changes
Your intubated patient is desatting from baseline. Patient is sleeping soundly. ETCO2 is higher than usual.You look at your ventilator and your tidal volumes are only 2-3/kg.
What would you do?
Suction
ASSESS! Breath sounds! Are they equal?
If not equal notify md!
Tube is most likely right mainstem.