Blood products

Cite this article as:
Anders, M. Blood products, Don't Forget the Bubbles, 2013. Available at:
http://doi.org/10.31440/DFTB.3678

Pump blood Pump blood is the blood remaining in the bypass circuit on the completion of bypass. It is a mixture of the patient’s own blood, other fluids and any bank blood used to prime the bypass circuit. Unfiltered pump blood has a low Hct and contains large amounts of heparin and inflammatory cytokines. The…

Anticoagulation

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Anders, M. Anticoagulation, Don't Forget the Bubbles, 2013. Available at:
http://doi.org/10.31440/DFTB.3723

UNFRACTIONATED HEPARIN (UFH) Indications: Low dose heparin infusions are used in the maintenance of central venous lines, arterial lines and the prevention and treatment of deep vein thromboses. Administration: Heparin can be administered by intravenous and subcutaneous routes. This protocol applies to the intravenous route only. Heparin is compatible with 5% dextrose, 0.9% NaCl and…

Inotropes and vasopressors

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Anders, M. Inotropes and vasopressors, Don't Forget the Bubbles, 2013. Available at:
http://doi.org/10.31440/DFTB.3876

Definition: Inotropes: sympathomimetic agent which act on the sympathetic (or adrenergic) nervous system (β-receptors) resulting in positive inotropic (increase in contractility), chronotropic (increase in heart rate), dromotropic (increase in conduction of impulse) and lusitropic effect (improved diastolic relaxation) Vasopressors: sympathomimetic agent which act on the sympathetic (or noradrenergic) nervous system (α-receptors) resulting in vasoconstrictor effect The ideal…

Analgesia and sedation

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Anders, M. Analgesia and sedation, Don't Forget the Bubbles, 2013. Available at:
http://doi.org/10.31440/DFTB.3867

Intravenous anaesthetic agents (see table): classified as barbiturates (thiopentone) and non-barbiturates (propofol and ketamine) thiopentone use is largely limited to induction in status epilepticus and for treatment of raised ICP; it has no analgesic properties and is in fact anti-analgesic at sedative doses propofol is suitable for induction (bolus) and maintenance of sedation/anaesthesia (infusion); it…

Myocarditis

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Anders, M. Myocarditis, Don't Forget the Bubbles, 2013. Available at:
http://doi.org/10.31440/DFTB.3794

See cardiomyopathy , but cardiac MRI or endomyocardial biopsy to confirm diagnosis Symptoms:  Very nonspecific in children: malaise, fever, poor appetite, tachypnea, tachycardia, chest pain, abdominal pain, myalgia, fatigue, cough, oedema, hepatomegaly, murmur. Investigations: See also cardiomyopathy Nonspecific T changes on ECG Cardiac enzymes are not elevated in most patients with myocarditis Echo is mandatory to…

Heart failure and ventricular assist device (VAD)

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Anders, M. Heart failure and ventricular assist device (VAD), Don't Forget the Bubbles, 2013. Available at:
http://doi.org/10.31440/DFTB.3790

Modified Ross heart failure classification: Class Symptoms I Asymptomatic II Mild tachypneoa or diaphoresis with feeding. Dyspnea on exertion in older children III Marked tachypnea or diaphoresis with feeding; marked dyspnea on exertion; prolonged feeding time with failure to thrive IV Tachypnea, retractions, grunting or diaphoresis at rest   Causes: Congenital, skeletal myopathy with cardiac involvment (e.g….

ECMO antibiotics

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Anders, M. ECMO antibiotics, Don't Forget the Bubbles, 2013. Available at:
http://doi.org/10.31440/DFTB.3783

Indication Prophylaxis Timing Duration ECMO (cannulation, chest revision, reoperation on ECMO, decannulation) – if not on anitbiotics with both gramnegative and grampositive cover already Cephazolin 50mg/kg up to 1g IV or (if cephazolin unavailable)Cephalothin 50mg/kg up to 2g IV Optimal timing for Beta-Lactams: administer 30 – 60min before incision 2nd dose 25mg/kg if operation > 3hrs, continue 25mg/kg 8hrly,…

ECMO

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Anders, M. ECMO, Don't Forget the Bubbles, 2013. Available at:
http://doi.org/10.31440/DFTB.3778

Inclusion criteria: >34/40 weeks gestation age, reversible cardiac, pulmonary, or cardiopulmonary failure, mechanical ventilation <14 days. Exclusion criteria: Major intracranial haemorrhage, lethal malformation, severe neurological injury, untreatable cardiac or pulmonary malformation. Clinical indications: Failure to wean off cardiopulmonary bypass, oxygenation index >40 on two or more ABG despite maximum therapy [OI = (MAP * FiO2…

Cardiomyopathy

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Anders, M. Cardiomyopathy, Don't Forget the Bubbles, 2013. Available at:
http://doi.org/10.31440/DFTB.3772

Basic investigation: ECG, CXR, ECHO, FBE, clotting, UEC  (incl. Ca++, Mg++, Fe++, PO4—), CRP, ESR, albumin, LFT, TFT, BNP, troponin I, troponin T, lactate, ABG, VBG. Extended investigation: Cardiac MRI. 24 hr Holter monitor. Blood: amino acids, carnitine, acyl-carnitine, ammonia, Cu, caeruloplasmin, transferrin ioforms, pyruvate, selenium, vitamins. Urine: amino acids, organic acids, pligosaccharide screen, MPS…

Berlin heart VAD Excor

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Anders, M. Berlin heart VAD Excor, Don't Forget the Bubbles, 2013. Available at:
http://doi.org/10.31440/DFTB.3797

Definition: Paracorporal, pneumatically driven, pulsatile flow mechanical support device driven by a central driving unit (Ikus®) and different sizes of blood pumps (10, 25, 30, 50, 60, 80ml), can be used as RVAD, LVAD or BIVAD. Aim: Bridge to transplant or bridge to recovery Standard settings: Driving pressures for Systole and Diastole (Chamber Size /…

ABO incompatible blood transfusion

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Anders, M. ABO incompatible blood transfusion, Don't Forget the Bubbles, 2013. Available at:
http://doi.org/10.31440/DFTB.3786

UNOS Policy: ABO incompatible HTX for children up to 2 years (with acceptable isohaemoglutinin titres – less than 1:4) Recipient Donor compatible Donor incompatible Antibodies to avoid Plasma / Platelets RBC 0 0 0 0 AB Anti AAnti B AB 0 0 A Anti A AB or A 0 0 B Anti B AB or B…