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Catastrophic Events. Brian Schwartz, CCP April 8, 2004. Catastrophic Events. As students you need to understand and anticipate the potential for a catastrophic event As students, you need to learn the proper responses and actions to take in the event of a catastrophic event.

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catastrophic events

Catastrophic Events

Brian Schwartz, CCP

April 8, 2004

catastrophic events2
Catastrophic Events
  • As students you need to understand and anticipate the potential for a catastrophic event
  • As students, you need to learn the proper responses and actions to take in the event of a catastrophic event
important statistics concerning catastrophic events
Important Statistics Concerning Catastrophic Events
  • Research shows that on the average, 1/300 cases has some sort of incident…not necessarily a catastrophic event
  • Research also shows that on the average, 1/1000 cases ends in patient death due to an event
  • It is your responsibility as a diligent perfusionist to prevent these statistics from occurring in your institution
factors that can prevent catastrophic events from occurring
Factors that Can Prevent Catastrophic Events from Occurring
  • Education
  • Experience
  • Training
  • Motivation
  • Communication
  • Ability to perform multiple tasks
  • Preventative measures
types of catastrophic events
Types of Catastrophic Events
  • Oxygenator failure
  • Water to Blood Leak
  • Air Embolism
  • Blood transfusion reaction
  • Protamine Reactions
oxygenator failure
Oxygenator Failure
  • Signs of an Oxygenator Failure
    • Decreased PO2
    • Decreased venous saturation
    • Elevated pCO2
  • Action
    • Notify surgeon and anesthesia
    • Take stat ABGO to verify
    • Get extra oxygenator ready and all other necessary equipment
    • Change out the oxygentor in a timely fashion
water to blood leak
Water to Blood Leak
  • Signs of a Leak
    • Sudden rise in blood volume (unexplainable)
    • Decrease in ph (patient getting acidotic)
    • Decrease in H/H
    • Blood in urine (hematuria)
  • Action to be taken
    • Notify Surgeon and Anesthesia
    • Get necessary help
    • Change out the oxygenator
massive air embolism
Massive Air Embolism
  • Safety Devices to Prevent the Introduction of Air to the Patient
    • Level sensors
    • Arterial filters
    • Bubble sensors
things to do to prevent the introduction of air embolisms
Things to do to Prevent the Introduction of Air Embolisms
  • Steps to take:
    • CO2 Flush the circuit before priming
    • Use albumin to coat circuit
    • Keep adequate volume status
    • Communication with surgeons
actions to take
Actions to take:
  • Immediately turn off the pump and clamp out your lines
  • Notify surgeons
  • Place patient in trenelenberg
  • Pack head in ice
  • Give steroids
  • Re-prime circuit
  • Hyperbaric Chamber
blood transfusion reactions
Blood Transfusion Reactions
  • Reason why patients develop transfusion reactions….
    • Recipient forms antibodies against donor RBC antigens
    • Reactions may be immediate or delayed
  • Prevention of Blood Transfusion Reactions
    • DOUBLE CHECKING BLOOD UNITS TO PATIENTS ID
actions to take if the wrong type of blood is given to a patient
Actions to Take if the Wrong Type of Blood is Given to a Patient
  • Immediately stop the transfusion
  • Notify the surgeons and anesthesia
  • Give steroids
  • Give diuretics
  • Give a complete blood transfusion with the proper blood type
  • Fill out incident report
protamine reactions
Protamine Reactions
  • Protamine, which is derived from the sperm of salmon, is used to reverse the effects of heparin
  • Patients at risk:
    • Allergies to shellfish
    • Prior exposure to protamine
    • Men with vasectomies
    • Patients on NPH insulin
types of protamine reactions
Types of Protamine Reactions
  • Type I
    • Hypotension related to the fast administration of protamine
  • Type II
    • Anaphylactic reaction resulting in decrease SVR, bronchospasm, and edema
  • Type III
    • Pulmonary vasoconstriction, RV distension, PA hypertension, decreased LV filling, and systemic hypotension
supportive measures to stop protamine reaction
Supportive Measures to Stop Protamine Reaction
  • Give Vasoactive Drugs
  • Give Inotropic Drugs
  • Give Pulmonary Vasodilators
  • Give Heparin to go back on CPB
the best way to prevent catastrophic events from occurring
The Best Way to Prevent Catastrophic Events from Occurring
  • Be Alert
  • Be Diligent
  • Be Prepared for the Unexpected
  • Always Communicate with the Team
  • Never Think it Won’t Happen on your Watch!!!!!!