Cardiopulmonary bypass effect to others organsIda Simanjuntak
Cardiopulmonary bypass can cause various effects including hyperglycemia, hypoglycemia, hematologic effects from platelet activation and inflammation, stress responses, cardiac effects from ischemia, potential for brain injury, lung injury from inflammation and mechanical effects, and renal effects from vasoconstriction. Hypothermia provides some protection during bypass by reducing metabolic rate and oxygen demand. Deep hypothermic circulatory arrest and hypothermic low-flow bypass are techniques used, with low-flow bypass showing potential benefits in reducing neural dysfunction. Anticoagulation with heparin and reversal with protamine is used but can cause bleeding complications.
Myocardial protection DR NIKUNJ R SHEKHADA (MBBS ,MS GRN SURG , DNB CTS SRDR NIKUNJ SHEKHADA
The document discusses various techniques for myocardial protection during cardiac surgery requiring cardiac arrest. It describes the historical development of cardioplegia including hypothermia, potassium-induced arrest, and developments in blood versus crystalloid cardioplegia solutions. Key aspects of myocardial protection discussed include rapid induction of arrest, hypothermia, buffering solutions to prevent acidosis, avoiding edema, and preventing substrate depletion during ischemia.
Microemboli during cardiac bypass procedures can reduce patient quality of life and cause strokes. Various emboli like gases, particulates, thrombi and biological material from the bypass apparatus and patient can lodge in organs. While emboli cannot be eliminated, their occurrence can be greatly reduced through measures like filters, membrane oxygenators, avoiding air, adequate anticoagulation, and flooding surgical fields with CO2. Prevention is emphasized as there is lack of effective treatment once emboli occur.
This document discusses two techniques for acid-base management during cardiac surgery using cardiopulmonary bypass (CPB): alpha-stat and pH-stat. Alpha-stat aims to maintain intracellular pH during hypothermia by not adding CO2 as temperature decreases. pH-stat adds CO2 to maintain blood pH at different temperatures. While pH-stat increases cerebral blood flow and cooling, it risks luxury perfusion and emboli. Alpha-stat preserves autoregulation but decreases blood flow, potentially reducing emboli risk. The optimal strategy may depend on the surgery and patient factors.
Immune system and inflamatory response to cpb(1)Manu Jacob
The document discusses the immune and inflammatory responses to cardiopulmonary bypass (CPB). It explains that CPB activates both the innate and acquired immune systems, inducing a complex inflammatory response known as the systemic inflammatory response syndrome (SIRS). SIRS can lead to organ dysfunction or failure in some patients. The document outlines the roles that various immune cells like neutrophils, monocytes, endothelial cells, and platelets play in mounting the inflammatory response to CPB. It also discusses how factors like contact with the CPB circuit, ischemia-reperfusion injury, and hypothermia can trigger and exacerbate this inflammatory cascade.
The cardiopulmonary bypass circuit must be primed with fluid to allow adequate blood flow without air embolism risks. Historically, whole blood was used but increased risks. Solutions now use crystalloids like lactated Ringer's or colloids like albumin and hydroxyethyl starch. Acceptable hemodilution is 25-30% hematocrit. Additional components like calcium, steroids, and bicarbonate are sometimes added. Adequacy of perfusion under hemodilution is assessed using measures like EEG, renal function, and blood gases.
This document provides an overview of hypertrophic cardiomyopathy (HCM). It begins with definitions of cardiomyopathy and HCM. It then discusses the historical perspective, genetic basis, morphology, pathophysiology, clinical features, diagnosis, and management of HCM. Some key points include:
- HCM is a genetic heart condition characterized by unexplained thickening of the heart muscle. It is the most common cause of sudden cardiac death in young people.
- The genetic basis involves mutations in genes encoding sarcomere proteins. This leads to impaired relaxation and increased calcium sensitivity of the heart muscle.
- Morphologically, HCM involves asymmetric left ventricular hypertrophy and abnormalities of the mitral valve apparatus. Hist
CARDIO PLEGIA DELIVERY DR NIKUNJ R SHEKHADA (MBBS,MS GEN SURG,DNB CTS SRDR NIKUNJ SHEKHADA
This document discusses different methods of delivering cardioplegia (chemicals that induce cardiac arrest) during cardiac surgery. It describes:
1. Intracellular and extracellular cardioplegia work by altering ion concentrations to prevent generation of action potentials and induce cardiac arrest.
2. Methods of delivery include antegrade (through coronary arteries), retrograde (through coronary sinus), intermittent, continuous, or a combination.
3. Retrograde delivery has advantages like reaching arteries with blockages, but risks include injury from high pressures in the coronary sinus.
Cardiopulmonary bypass effect to others organsIda Simanjuntak
Cardiopulmonary bypass can cause various effects including hyperglycemia, hypoglycemia, hematologic effects from platelet activation and inflammation, stress responses, cardiac effects from ischemia, potential for brain injury, lung injury from inflammation and mechanical effects, and renal effects from vasoconstriction. Hypothermia provides some protection during bypass by reducing metabolic rate and oxygen demand. Deep hypothermic circulatory arrest and hypothermic low-flow bypass are techniques used, with low-flow bypass showing potential benefits in reducing neural dysfunction. Anticoagulation with heparin and reversal with protamine is used but can cause bleeding complications.
Myocardial protection DR NIKUNJ R SHEKHADA (MBBS ,MS GRN SURG , DNB CTS SRDR NIKUNJ SHEKHADA
The document discusses various techniques for myocardial protection during cardiac surgery requiring cardiac arrest. It describes the historical development of cardioplegia including hypothermia, potassium-induced arrest, and developments in blood versus crystalloid cardioplegia solutions. Key aspects of myocardial protection discussed include rapid induction of arrest, hypothermia, buffering solutions to prevent acidosis, avoiding edema, and preventing substrate depletion during ischemia.
Microemboli during cardiac bypass procedures can reduce patient quality of life and cause strokes. Various emboli like gases, particulates, thrombi and biological material from the bypass apparatus and patient can lodge in organs. While emboli cannot be eliminated, their occurrence can be greatly reduced through measures like filters, membrane oxygenators, avoiding air, adequate anticoagulation, and flooding surgical fields with CO2. Prevention is emphasized as there is lack of effective treatment once emboli occur.
This document discusses two techniques for acid-base management during cardiac surgery using cardiopulmonary bypass (CPB): alpha-stat and pH-stat. Alpha-stat aims to maintain intracellular pH during hypothermia by not adding CO2 as temperature decreases. pH-stat adds CO2 to maintain blood pH at different temperatures. While pH-stat increases cerebral blood flow and cooling, it risks luxury perfusion and emboli. Alpha-stat preserves autoregulation but decreases blood flow, potentially reducing emboli risk. The optimal strategy may depend on the surgery and patient factors.
Immune system and inflamatory response to cpb(1)Manu Jacob
The document discusses the immune and inflammatory responses to cardiopulmonary bypass (CPB). It explains that CPB activates both the innate and acquired immune systems, inducing a complex inflammatory response known as the systemic inflammatory response syndrome (SIRS). SIRS can lead to organ dysfunction or failure in some patients. The document outlines the roles that various immune cells like neutrophils, monocytes, endothelial cells, and platelets play in mounting the inflammatory response to CPB. It also discusses how factors like contact with the CPB circuit, ischemia-reperfusion injury, and hypothermia can trigger and exacerbate this inflammatory cascade.
The cardiopulmonary bypass circuit must be primed with fluid to allow adequate blood flow without air embolism risks. Historically, whole blood was used but increased risks. Solutions now use crystalloids like lactated Ringer's or colloids like albumin and hydroxyethyl starch. Acceptable hemodilution is 25-30% hematocrit. Additional components like calcium, steroids, and bicarbonate are sometimes added. Adequacy of perfusion under hemodilution is assessed using measures like EEG, renal function, and blood gases.
This document provides an overview of hypertrophic cardiomyopathy (HCM). It begins with definitions of cardiomyopathy and HCM. It then discusses the historical perspective, genetic basis, morphology, pathophysiology, clinical features, diagnosis, and management of HCM. Some key points include:
- HCM is a genetic heart condition characterized by unexplained thickening of the heart muscle. It is the most common cause of sudden cardiac death in young people.
- The genetic basis involves mutations in genes encoding sarcomere proteins. This leads to impaired relaxation and increased calcium sensitivity of the heart muscle.
- Morphologically, HCM involves asymmetric left ventricular hypertrophy and abnormalities of the mitral valve apparatus. Hist
CARDIO PLEGIA DELIVERY DR NIKUNJ R SHEKHADA (MBBS,MS GEN SURG,DNB CTS SRDR NIKUNJ SHEKHADA
This document discusses different methods of delivering cardioplegia (chemicals that induce cardiac arrest) during cardiac surgery. It describes:
1. Intracellular and extracellular cardioplegia work by altering ion concentrations to prevent generation of action potentials and induce cardiac arrest.
2. Methods of delivery include antegrade (through coronary arteries), retrograde (through coronary sinus), intermittent, continuous, or a combination.
3. Retrograde delivery has advantages like reaching arteries with blockages, but risks include injury from high pressures in the coronary sinus.
Ventricular arrhythmias originate in the ventricles and include premature ventricular contractions, ventricular tachycardia, and ventricular fibrillation. Ventricular tachycardia is defined as three or more consecutive ventricular beats at a rate over 100 beats per minute and can be caused by mechanisms like reentry, automaticity, and triggered activity. Polymorphic ventricular tachycardia includes conditions like torsades de pointes and Brugada syndrome. Acute management of sustained ventricular tachycardia includes termination attempts using antiarrhythmic drugs or cardioversion, while long term prevention focuses on drugs, ablation, or implantable cardioverter defibrillators depending on symptoms and left ventricular function.
7 Adequacy Of Perfusion During Cardiopulmonary BypassDang Thanh Tuan
The document discusses various parameters for determining the adequacy of perfusion during cardiopulmonary bypass (CPB), including arterial flow rates, pressures, hematocrit levels, oxygen consumption, and venous oxygen saturation. While standards were established decades ago, newer evidence suggests the need to re-evaluate perfusion techniques given improvements in CPB systems and reports of adverse neurological outcomes. A range of factors like patient characteristics, anesthesia, and disease states can impact optimal perfusion values.
The document discusses the interaction between blood and non-endothelial surfaces during extracorporeal circulation (ECC) like cardiopulmonary bypass (CPB). Exposure of blood to these surfaces triggers coagulation, inflammation, and other defense reactions. Heparin is used to prevent clotting but has drawbacks. Newer direct thrombin inhibitors like argatroban and bivalirudin are alternatives but require monitoring. Platelets and other blood components activate during ECC, potentially causing complications. Properties of biomaterials, anticoagulation methods, and patient factors influence the intensity of these defense reactions.
This document discusses safety protocols for cardiopulmonary bypass (CPB). It notes that fatal perfusion accidents occurred in 1 in 1800 cases in 1981, with serious incidents in 1 in 130 procedures. Standards have improved with better safety features and techniques. It emphasizes organizational aspects like teamwork, cooperation and effective communication. It recommends establishing equipment records, a faults book, agreed perfusion protocols, and procedures for equipment failures. Patient specific safety protocols include identification, machine checks, priming according to protocol, and ensuring identification on equipment and fluids used. Accidents can be due to human error or equipment failures. Reduced oxygenation and arterial line air embolism are discussed as common perfusion incidents. Guidelines for managing gross air e
Deep hypothermic circulatory arrest (DHCA) is a technique used in cardiac surgery to facilitate operations on the aortic arch. It involves inducing circulatory arrest through deep hypothermia to prevent ischemic injury while working on the aortic arch. Various neuroprotective strategies are used like pharmacological neuroprotection, neurological monitoring, and cerebral perfusion techniques like antegrade cerebral perfusion and retrograde cerebral perfusion to extend the safe duration of DHCA. Optimal temperature management and the differences between unilateral versus bilateral cerebral perfusion are factors considered to reduce neurocognitive risks of DHCA.
This document outlines the key steps and considerations for safely conducting cardio-pulmonary bypass (CPB). It discusses monitoring patient physiology and equipment, priming the circuit, initiating and managing bypass, and post-bypass activities. Conducting CPB requires a multidisciplinary team with effective communication. Patient temperature, blood flow rates, oxygen delivery and other variables must be carefully monitored to ensure adequate tissue perfusion. Thorough documentation in perfusion records is also important. Protocols and checklists can help standardize the process while still allowing for clinical judgment. The overall goal is to support the patient's cardiovascular and respiratory functions during surgery.
The document discusses various strategies for myocardial protection during cardiac surgery. It outlines the history of techniques from hypothermia to cardioplegia. Cardioplegic techniques can be delivered antegrade, retrograde, or in combinations. Cold crystalloid or blood cardioplegia are commonly used to induce cardiac arrest. Blood cardioplegia provides benefits like oxygenation and buffering. Warm or tepid blood cardioplegia techniques are also investigated. Areas under further study include ischemic preconditioning, postconditioning, and molecular targets to reduce ischemia-reperfusion injury from cardiac surgery.
ECG changes in myocardial Ischemia and injurySarah Sreekanth
This document discusses myocardial ischemia and injury as seen on electrocardiograms (ECGs). It notes that ischemia is caused by a mismatch between blood supply and demand in the heart muscle. If blood flow is restored before glycogen is depleted, the cells can resume contraction, but if depletion occurs, the cells become "stunned" or can die off, leading to infarction. ECG changes like T wave inversion or ST segment depression reflect ischemia or injury and confer prognostic significance, as around 20% of patients with these changes may experience future cardiac events. The document outlines specific patterns of ST segment depression and elevation seen in ECGs that indicate myocardial injury.
4.hemo filtration & blood conservation techniqueManu Jacob
This document discusses techniques for hemofiltration, blood conservation, and ultrafiltration during cardiopulmonary bypass. It describes:
1. Ultrafiltration and hemofiltration remove fluid and solutes from the bloodstream using semipermeable membranes to create concentration gradients. This can effectively remove edema and concentrate blood.
2. Modified ultrafiltration after bypass can immediately increase hematocrit, decrease right atrial pressure, and improve organ function and hemostasis.
3. Blood conservation techniques during cardiac surgery aim to reduce blood transfusion needs through measures like autologous donation, cell savers to retrieve shed blood, and minimizing priming volume.
This document outlines several potential complications that can occur following cardiac surgery, including decreased cardiac output due to hypovolemia, bleeding, or cardiac tamponade; fluid overload; hypothermia; hypertension; tachydysrhythmias; bradycardias; cardiac failure; myocardial infarction; pulmonary complications; neurologic changes and stroke; renal failure and electrolyte imbalances; infection; and hepatic failure. Assessment and management strategies are provided for each complication.
This document provides information on congestive heart failure (CHF), including its definition, pathophysiology, signs and symptoms, causes, precipitating factors, evaluation, monitoring, and management. CHF can be caused by conditions that weaken the heart muscle such as heart attacks or cardiomyopathy. It occurs when the heart cannot pump sufficiently due to problems with its electrical or mechanical function. Management involves treating underlying causes, reducing preload and afterload on the heart, and increasing cardiac contractility and output with medications, oxygen, and potentially devices like intra-aortic balloon pumps.
This document provides an overview of cardiogenic shock (CS) from an internal medicine perspective. It aims to provide a clinical "toolbox" for diagnosing, differentiating, and managing shock, with an emphasis on cardiovascular etiologies. Part I discusses the initial evaluation of a hypotensive patient in shock, including assessing cardiac rhythm and rate, conducting a physical exam, and raising blood pressure by administering fluids. Part II notes that further consideration is needed when treating CS, such as feeling free to drift off. The document discusses evaluating objective data, differentiating shock types, selecting appropriate pressors/inotropes, and controversies regarding first-line vasoactive agents.
This document discusses various topics related to cardioplegia, including alternative arresting agents and additives, crystalloid versus blood cardioplegia, and potential new technologies. It provides details on adenosine receptors, minute work and oxygen demand, alternative arresting agents such as beta blockers and adenocaine, agents affecting calcium transport, and ways to avoid substrate depletion. It compares crystalloid and blood cardioplegia, outlining advantages and disadvantages of each. Finally, it discusses novel strategies for cardioprotection such as ischemic preconditioning, post-conditioning, and remote ischemic preconditioning.
Cardiogenic shock is defined as persistent hypotension and hypoperfusion due to cardiac dysfunction with adequate filling pressures. It is commonly caused by left ventricular failure due to an extensive acute myocardial infarction. Signs include low blood pressure, decreased cardiac output, and signs of hypoperfusion. Treatment involves optimizing preload, inotropic support, vasopressor therapy, and mechanical circulatory support such as IABP or VAD if refractory to medical management.
1. Conduct of perfusion begins hours before CPB and involves assembling equipment, reviewing patient charts, calculating parameters, and priming the circuit.
2. Prior to initiating CPB, the perfusionist completes a safety checklist and confirms that all components are properly set up and functioning.
3. Once CPB begins, the perfusionist continuously monitors various parameters like blood flow, pressure, and oxygen levels and makes adjustments as needed throughout the procedure.
Heat exchangers are used in cardiopulmonary bypass to regulate the temperature of blood perfusing the patient. Heat is transferred between the blood and a circulating water supply via conduction and convection. The heat exchanger is separated from the blood to prevent activation. It has a large surface area and countercurrent flow to maximize heat transfer while minimizing outgassing from rapid temperature changes. Precise temperature control is achieved using a heater-cooler unit connected to the water circulation.
This document discusses the history and techniques of priming fluids and hemodilution in cardiopulmonary bypass. It notes that early surgeons used whole blood for priming, while later techniques incorporated saline and dextrose solutions to enable hemodilution. Hemodilution provides benefits like reduced blood viscosity and improved oxygen delivery, but can cause issues like decreased oxygen carrying capacity if taken to an extreme. The document examines various priming fluid options and how hemodilution affects viscosity, oxygen transport, and hematocrit. Overall, priming fluids and controlled hemodilution have advanced CPB by enabling adequate organ perfusion in difficult circumstances and reducing complications while conserving blood.
Ventricular tachycardia can occur due to various causes like acute myocardial infarction, chronic infarction, dilated cardiomyopathy, etc. It is classified as sustained, non-sustained, monomorphic, polymorphic, etc. based on characteristics. Diagnosis involves ECG, echocardiogram, and monitoring. Treatment depends on hemodynamic stability and includes electrical cardioversion, antiarrhythmic drugs like amiodarone, lidocaine, ablation, and ICD implantation in selected cases. Recurrence risk is high in structurally abnormal hearts and prevention involves controlling triggers, antiarrhythmics, and ICDs.
Ventricular arrhythmias originate in the ventricles and include premature ventricular contractions, ventricular tachycardia, and ventricular fibrillation. Ventricular tachycardia is defined as three or more consecutive ventricular beats at a rate over 100 beats per minute and can be caused by mechanisms like reentry, automaticity, and triggered activity. Polymorphic ventricular tachycardia includes conditions like torsades de pointes and Brugada syndrome. Acute management of sustained ventricular tachycardia includes termination attempts using antiarrhythmic drugs or cardioversion, while long term prevention focuses on drugs, ablation, or implantable cardioverter defibrillators depending on symptoms and left ventricular function.
7 Adequacy Of Perfusion During Cardiopulmonary BypassDang Thanh Tuan
The document discusses various parameters for determining the adequacy of perfusion during cardiopulmonary bypass (CPB), including arterial flow rates, pressures, hematocrit levels, oxygen consumption, and venous oxygen saturation. While standards were established decades ago, newer evidence suggests the need to re-evaluate perfusion techniques given improvements in CPB systems and reports of adverse neurological outcomes. A range of factors like patient characteristics, anesthesia, and disease states can impact optimal perfusion values.
The document discusses the interaction between blood and non-endothelial surfaces during extracorporeal circulation (ECC) like cardiopulmonary bypass (CPB). Exposure of blood to these surfaces triggers coagulation, inflammation, and other defense reactions. Heparin is used to prevent clotting but has drawbacks. Newer direct thrombin inhibitors like argatroban and bivalirudin are alternatives but require monitoring. Platelets and other blood components activate during ECC, potentially causing complications. Properties of biomaterials, anticoagulation methods, and patient factors influence the intensity of these defense reactions.
This document discusses safety protocols for cardiopulmonary bypass (CPB). It notes that fatal perfusion accidents occurred in 1 in 1800 cases in 1981, with serious incidents in 1 in 130 procedures. Standards have improved with better safety features and techniques. It emphasizes organizational aspects like teamwork, cooperation and effective communication. It recommends establishing equipment records, a faults book, agreed perfusion protocols, and procedures for equipment failures. Patient specific safety protocols include identification, machine checks, priming according to protocol, and ensuring identification on equipment and fluids used. Accidents can be due to human error or equipment failures. Reduced oxygenation and arterial line air embolism are discussed as common perfusion incidents. Guidelines for managing gross air e
Deep hypothermic circulatory arrest (DHCA) is a technique used in cardiac surgery to facilitate operations on the aortic arch. It involves inducing circulatory arrest through deep hypothermia to prevent ischemic injury while working on the aortic arch. Various neuroprotective strategies are used like pharmacological neuroprotection, neurological monitoring, and cerebral perfusion techniques like antegrade cerebral perfusion and retrograde cerebral perfusion to extend the safe duration of DHCA. Optimal temperature management and the differences between unilateral versus bilateral cerebral perfusion are factors considered to reduce neurocognitive risks of DHCA.
This document outlines the key steps and considerations for safely conducting cardio-pulmonary bypass (CPB). It discusses monitoring patient physiology and equipment, priming the circuit, initiating and managing bypass, and post-bypass activities. Conducting CPB requires a multidisciplinary team with effective communication. Patient temperature, blood flow rates, oxygen delivery and other variables must be carefully monitored to ensure adequate tissue perfusion. Thorough documentation in perfusion records is also important. Protocols and checklists can help standardize the process while still allowing for clinical judgment. The overall goal is to support the patient's cardiovascular and respiratory functions during surgery.
The document discusses various strategies for myocardial protection during cardiac surgery. It outlines the history of techniques from hypothermia to cardioplegia. Cardioplegic techniques can be delivered antegrade, retrograde, or in combinations. Cold crystalloid or blood cardioplegia are commonly used to induce cardiac arrest. Blood cardioplegia provides benefits like oxygenation and buffering. Warm or tepid blood cardioplegia techniques are also investigated. Areas under further study include ischemic preconditioning, postconditioning, and molecular targets to reduce ischemia-reperfusion injury from cardiac surgery.
ECG changes in myocardial Ischemia and injurySarah Sreekanth
This document discusses myocardial ischemia and injury as seen on electrocardiograms (ECGs). It notes that ischemia is caused by a mismatch between blood supply and demand in the heart muscle. If blood flow is restored before glycogen is depleted, the cells can resume contraction, but if depletion occurs, the cells become "stunned" or can die off, leading to infarction. ECG changes like T wave inversion or ST segment depression reflect ischemia or injury and confer prognostic significance, as around 20% of patients with these changes may experience future cardiac events. The document outlines specific patterns of ST segment depression and elevation seen in ECGs that indicate myocardial injury.
4.hemo filtration & blood conservation techniqueManu Jacob
This document discusses techniques for hemofiltration, blood conservation, and ultrafiltration during cardiopulmonary bypass. It describes:
1. Ultrafiltration and hemofiltration remove fluid and solutes from the bloodstream using semipermeable membranes to create concentration gradients. This can effectively remove edema and concentrate blood.
2. Modified ultrafiltration after bypass can immediately increase hematocrit, decrease right atrial pressure, and improve organ function and hemostasis.
3. Blood conservation techniques during cardiac surgery aim to reduce blood transfusion needs through measures like autologous donation, cell savers to retrieve shed blood, and minimizing priming volume.
This document outlines several potential complications that can occur following cardiac surgery, including decreased cardiac output due to hypovolemia, bleeding, or cardiac tamponade; fluid overload; hypothermia; hypertension; tachydysrhythmias; bradycardias; cardiac failure; myocardial infarction; pulmonary complications; neurologic changes and stroke; renal failure and electrolyte imbalances; infection; and hepatic failure. Assessment and management strategies are provided for each complication.
This document provides information on congestive heart failure (CHF), including its definition, pathophysiology, signs and symptoms, causes, precipitating factors, evaluation, monitoring, and management. CHF can be caused by conditions that weaken the heart muscle such as heart attacks or cardiomyopathy. It occurs when the heart cannot pump sufficiently due to problems with its electrical or mechanical function. Management involves treating underlying causes, reducing preload and afterload on the heart, and increasing cardiac contractility and output with medications, oxygen, and potentially devices like intra-aortic balloon pumps.
This document provides an overview of cardiogenic shock (CS) from an internal medicine perspective. It aims to provide a clinical "toolbox" for diagnosing, differentiating, and managing shock, with an emphasis on cardiovascular etiologies. Part I discusses the initial evaluation of a hypotensive patient in shock, including assessing cardiac rhythm and rate, conducting a physical exam, and raising blood pressure by administering fluids. Part II notes that further consideration is needed when treating CS, such as feeling free to drift off. The document discusses evaluating objective data, differentiating shock types, selecting appropriate pressors/inotropes, and controversies regarding first-line vasoactive agents.
This document discusses various topics related to cardioplegia, including alternative arresting agents and additives, crystalloid versus blood cardioplegia, and potential new technologies. It provides details on adenosine receptors, minute work and oxygen demand, alternative arresting agents such as beta blockers and adenocaine, agents affecting calcium transport, and ways to avoid substrate depletion. It compares crystalloid and blood cardioplegia, outlining advantages and disadvantages of each. Finally, it discusses novel strategies for cardioprotection such as ischemic preconditioning, post-conditioning, and remote ischemic preconditioning.
Cardiogenic shock is defined as persistent hypotension and hypoperfusion due to cardiac dysfunction with adequate filling pressures. It is commonly caused by left ventricular failure due to an extensive acute myocardial infarction. Signs include low blood pressure, decreased cardiac output, and signs of hypoperfusion. Treatment involves optimizing preload, inotropic support, vasopressor therapy, and mechanical circulatory support such as IABP or VAD if refractory to medical management.
1. Conduct of perfusion begins hours before CPB and involves assembling equipment, reviewing patient charts, calculating parameters, and priming the circuit.
2. Prior to initiating CPB, the perfusionist completes a safety checklist and confirms that all components are properly set up and functioning.
3. Once CPB begins, the perfusionist continuously monitors various parameters like blood flow, pressure, and oxygen levels and makes adjustments as needed throughout the procedure.
Heat exchangers are used in cardiopulmonary bypass to regulate the temperature of blood perfusing the patient. Heat is transferred between the blood and a circulating water supply via conduction and convection. The heat exchanger is separated from the blood to prevent activation. It has a large surface area and countercurrent flow to maximize heat transfer while minimizing outgassing from rapid temperature changes. Precise temperature control is achieved using a heater-cooler unit connected to the water circulation.
This document discusses the history and techniques of priming fluids and hemodilution in cardiopulmonary bypass. It notes that early surgeons used whole blood for priming, while later techniques incorporated saline and dextrose solutions to enable hemodilution. Hemodilution provides benefits like reduced blood viscosity and improved oxygen delivery, but can cause issues like decreased oxygen carrying capacity if taken to an extreme. The document examines various priming fluid options and how hemodilution affects viscosity, oxygen transport, and hematocrit. Overall, priming fluids and controlled hemodilution have advanced CPB by enabling adequate organ perfusion in difficult circumstances and reducing complications while conserving blood.
Ventricular tachycardia can occur due to various causes like acute myocardial infarction, chronic infarction, dilated cardiomyopathy, etc. It is classified as sustained, non-sustained, monomorphic, polymorphic, etc. based on characteristics. Diagnosis involves ECG, echocardiogram, and monitoring. Treatment depends on hemodynamic stability and includes electrical cardioversion, antiarrhythmic drugs like amiodarone, lidocaine, ablation, and ICD implantation in selected cases. Recurrence risk is high in structurally abnormal hearts and prevention involves controlling triggers, antiarrhythmics, and ICDs.
- The document discusses different types of single-phase induction motors including split-phase, capacitor-start, and two-value capacitor motors.
- It describes the double revolving field theory which explains how a single-phase motor produces torque through two rotating magnetic fields.
- Tests like no-load and blocked rotor are discussed to determine the equivalent circuit parameters of a single-phase induction motor.
2020 Deep learning based detection and analysis of COVID-19 on chest X-ray im...ssuser7fd2a9
This document discusses using deep learning models to analyze chest X-ray images to detect COVID-19. It analyzes three deep learning models (Inception V3, Xception, ResNeXt) on a dataset of 6432 chest X-ray images from Kaggle to classify images as normal, COVID-19, or pneumonia. The Xception model achieved the highest accuracy of 97.97% for detecting COVID-19 in chest X-ray images compared to the other models.
9. Acute Coronary Syndrome
The spectrum of clinical conditions
ranging from:
unstable angina
non-Q wave MI
Q-wave MI
characterized by the common
pathophysiology of a disrupted
atheroslerotic plaque
