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Catastrophic Events

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

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  1. Catastrophic Events Brian Schwartz, CCP April 8, 2004

  2. 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

  3. 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

  4. Factors that Can Prevent Catastrophic Events from Occurring • Education • Experience • Training • Motivation • Communication • Ability to perform multiple tasks • Preventative measures

  5. Types of Catastrophic Events • Oxygenator failure • Water to Blood Leak • Air Embolism • Blood transfusion reaction • Protamine Reactions

  6. 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

  7. 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

  8. Massive Air Embolism • Safety Devices to Prevent the Introduction of Air to the Patient • Level sensors • Arterial filters • Bubble sensors

  9. 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

  10. 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

  11. 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

  12. 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

  13. 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

  14. 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

  15. Supportive Measures to Stop Protamine Reaction • Give Vasoactive Drugs • Give Inotropic Drugs • Give Pulmonary Vasodilators • Give Heparin to go back on CPB

  16. 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!!!!!!

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