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    Fadc 14155 Dac 7

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    Clamps the aorta Surgeon: Verifies clamping 6. Cardioplegia: 7. Surgical time: Begins myocardial revascularization... 8. Remove clamp: 9. C.E.C: 10. Closing time: 11. Protamine dose: 12. Finish time: SURGICAL PROCESS TIME 1. Opening time: 8:30 am 2. Heparin dose time: 8:35 am 3. Vascular time: 8:40 am 4. Entry in C.E.C: 8:45 am 5. Aortic campleo: 8

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    Fadc 14155 Dac 7

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    80 vistas28 páginas
    Clamps the aorta Surgeon: Verifies clamping 6. Cardioplegia: 7. Surgical time: Begins myocardial revascularization... 8. Remove clamp: 9. C.E.C: 10. Closing time: 11. Protamine dose: 12. Finish time: SURGICAL PROCESS TIME 1. Opening time: 8:30 am 2. Heparin dose time: 8:35 am 3. Vascular time: 8:40 am 4. Entry in C.E.C: 8:45 am 5. Aortic campleo: 8

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    Clamps the aorta Surgeon: Verifies clamping 6. Cardioplegia: 7. Surgical time: Begins myocardial revascularization... 8. Remove clamp: 9. C.E.C: 10. Closing time: 11. Protamine dose: 12. Finish time: SURGICAL PROCESS TIME 1. Opening time: 8:30 am 2. Heparin dose time: 8:35 am 3. Vascular time: 8:40 am 4. Entry in C.E.C: 8:45 am 5. Aortic campleo: 8

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    80 vistas28 páginas

    Fadc 14155 Dac 7

    Cargado por

    api-725606760
    Clamps the aorta Surgeon: Verifies clamping 6. Cardioplegia: 7. Surgical time: Begins myocardial revascularization... 8. Remove clamp: 9. C.E.C: 10. Closing time: 11. Protamine dose: 12. Finish time: SURGICAL PROCESS TIME 1. Opening time: 8:30 am 2. Heparin dose time: 8:35 am 3. Vascular time: 8:40 am 4. Entry in C.E.C: 8:45 am 5. Aortic campleo: 8

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    de 28

    FRONT PAGE

    CLINICAL CASE

    LAURA VANESSA ARIAS RODRIGUEZ

    HEART INSTITUTE OF BUCARAMANCA

    FIRST SURGICAL PRACTICE ROTATION UDES

    2024A
    Clinical Case Cardiovascular Surgery

    Patient’s Data:
    • Name: Luis Rafael Gomez Rodriguez.

    • ID: 13876429
    • Age: 75 years
    • Sex: Male
    • Birthdate: 18/02/1949
    • Civil status: Married
    • Blood type: O+
    • Address: Route 27A number 122-27 tower 2 apartment 503 The Florida
    • Occupation: Teacher's retired
    RECORD
    • Pathological: (Diseases)
    Multivessel Coronary Artery Disease - Moderate Aortic Valve Failure

    • Pharmacological: (medications)
    Atorvastatina: Utilizado para disminuir los niveles de colesterol en sangre y en la
    prevención de enfermedades cardiovasculares, estabiliza las placas y previene la
    embolia mediante mecanismos antiinflamatorios.

    Ezetimiba: Su acción consiste en impedir la absorción del colesterol en el intestino.

    Metoprolol: Se usa solo o en combinación con otros medicamentos para tratar la


    presión arterial alta, también se usa para tratar la angina (dolor de pecho) crónica (a
    largo plazo). El metoprolol también se usa para mejorar la supervivencia después de
    sufrir un ataque cardíaco.
    Sitagliptina: agente antidiabético oral que está indicado en el tratamiento de la
    diabetes mellitus de tipo 2, con el objetivo de disminuir la insulinorresistencia.

    Empagliflozina: La empagliflozina pertenece a una clase de medicamentos


    llamados inhibidores del cotransportador de sodio glucosa 2. Disminuye el nivel de
    azúcar en la sangre haciendo que los riñones eliminen más glucosa en la orina.

    Memantina: Trata los síntomas de la enfermedad de Alzheimer de moderada a


    grave bloqueando los efectos tóxicos asociados con el exceso de glutamato y regula
    la activación del glutamato.

    • Surgical: (Previous surgeries)

    Inguinal hernia
    DIAGNOSTIC EXAMS
    • Diagnostic Images:

    o Echocardiogram
    RESULTS
    • Left ventricle with normal diameters
    • Mild basal hypertrophy of the
    interventricular septum.
    • Preserved left ventricular systolic
    function EF 66%.
    • Moderate aortic valve insufficiency, mild
    mitral insufficiency.

    o EKG
    RESULTS
    1. Sinus rhythm
    2. Normal electrical axis
    3. No ST-axis alterations
    observed
    DIAGNOSTIC EXAMS
    • Diagnostic Images:
    LEFT CORONARY ARTERY: Ostium and trunk without lesions
    o Arteriography
    ANTERIOR DESCENDENT: Type II artery with critical lesion in proximal
    segment, with its branches permeable.

    CIRCUNFLEJA AND INTERMEDIATE RAMUS: Arteries with significant


    lesions in proximal area.

    RIGHT CORONARY: Dominant artery, calcified with plaques, posterior


    descending with patent stenting

    THORACIC AORTOGRAM: Aortic valve with severe insufficiency.


    DIAGNOSTIC EXAMS
    • Diagnostic Images:

    o Holtter (N/A)
    o RX of chest: Normal cardiac silhouette without consolidations or effusions.

    • Paraclinics:
    o Laboratories

    • Dental treatment (N/A)


    Surgical Foundation

    TWO-VESSEL MYOCARDIAL REVASCULARIZATION

    Myocardial revascularization surgery consists of the recanalization of one or more occluded


    coronary circulation paths through anastomosis (junctions) with new vascular segments
    (autografts) either venous or arterial from the same patient according to the surgeon's
    criteria.
    Mammary artery and saphenous vein grafts are performed in the anterior descending (90%)
    and circumflex veins (90%).
    PATIENT PREPARATION AND TABLES

    • Type of washing: Total washing with alcohol and isopropyl alcohol.


    • Type of anesthesia: General
    • Position: Decubitus supine
    • Type of dressed: Dressed leaving thorax exposed and left leg area uncovered.
    PATIENT PREPARATION AND TABLES
    • MAY TABLE
    1. MB# 3 HB# 15
    2. MB#7 HB# 15
    3. MB#7 HB# 11
    4. Metzembaum scissors (2)
    5. May scissors (2)
    6. Farabeuf separators (2 pairs)
    7. Mosquito Forceps curved
    8. Protected Mosquito Forceps
    9. Straight Kelly Forceps
    10. Curved Kelly Forceps
    11. Adson Kelly Forceps
    12. Cystic forceps .
    13. Rochester Forceps
    14. Tube clamp
    15. Vascular dissection forceps
    16. Adson dissecting forceps with clamp
    17. Coca for sharps + field fórceps
    18. Diethrich scissors anterograde and retrograde
    19. Castroviejo needle holder

    20. Pre cut silk 1 and 4/0


    PATIENT PREPARATION AND TABLES
    • RESERVATION TABLE
    SURGICAL INSTRUMENTATION PROCESS

    Surgical Planning:

    • Body surface: 1.8

    • Flow: 4.5

    • Heparin dose: 5.25


    • Z value: Z: 0 = 20.3 Z: -2 = 16.8 Z: +2 = 23.9

    • AOE: 1.53
    SURGICAL INSTRUMENTATION PROCESS

    Check list: (todo de manera gráfica)

    • Instrumental (basket, separator ...)


    SURGICAL INSTRUMENTATION PROCESS

    Check list: (todo de manera gráfica)

    • Equipment (defibrillator, saw, electro console ...)


    SURGICAL INSTRUMENTATION PROCESS

    Check list: (todo de manera gráfica)

    • Basic medical devices (all the car)


    SURGICAL INSTRUMENTATION PROCESS

    Check list: (todo de manera gráfica)

    • Specialized medical devices

    • Perfusion devices
    SURGICAL INSTRUMENTATION PROCESS

    Check list: (todo de manera gráfica) Wire suture # 6


    Bone wax
    • Sutures
    FOR SUTURING SKIN
    (2) Polyglecaprone 25 3/0 - cutting needle 3/8
    circle 19 mm

    SUBCUTANEOUS CELLULAR TISSUE


    Poliglactin 910 0 - round needle 1/2 circle
    36.4mm (2)

    Poliglactin 910 2/0 - round needle 1/2 circle


    36.4mm (1) - IM

    FOR TOBACCO POUCH IN CARDIOPLEGIA PROBE


    Polypropylene 6/0 - double round needle 1/2
    circle 17mm (2)

    Pre-cut silk 4/0

    TO FIX THE CHEST TUBE # 34 and #32

    MARCAPASUS SUTURE (TEMPOWIRE) 2/0 - round FOR THE SAPHENOUS AND MAMMARY VEIN (Polyester) 2/0 - needle 1/2 circle double
    needle 1/2 circle 26mm (1) Pre cut Silk 4/0 needle 26mm

    FOR TOBACCO POUCHES AND TIE DOWN THE CORONARY ANASTOMOSIS FOR REPAIRING THE PERICARDIUM
    TURNSTILES Polypropylene 7/0 – 8/0 double round needle Silk 0 - round needle 1/2 circle 17mm
    Pre cut Silk 0 1/2 circle 17mm (2)

    Ti -cron suture (Polyester) 2/0 - needle 1/2 circle Polypropylene 6/0 3/8 round circle 13mm
    double needle 25mm
    SURGICAL INSTRUMENTATION PROCESS

    Check list: (todo de manera gráfica)

    • Hemostats
    SURGICAL PROCESS

    TIME

    1. Opening time
    2. heparin dose time
    3. Vascular time (canulation)
    4. Entry in C.E.C
    5. Aortic campleo
    6. Cardioplejia
    7. Surgical time
    8. Remove clamp
    9. C.E.C
    10.CLOSING TIME
    11.Protamine dossis
    12.Finish time (expenses sheet filing (administrative process, central central process) and enlistment of the following surgery)
    SURGICAL PROCESS
    TIME
    SURGICAL PROCESS
    1. Opening time
    SURGICAL PROCESS

    2. Heparin dose time: The patient is administered 5.25 IU/kg

    3. Vascular time:
    SURGICAL PROCESS

    4. Entry in C.E.C:

    5. Aortic Campleo:
    SURGICAL PROCESS
    6. Cardioplejia: With the help of the perfusionist, the blood cardioplegia step is done

    7. Surgicaltime :
    SURGICAL PROCESS

    8. Remove clamp

    9. C.E.C
    SURGICAL PROCESS
    10. CLOSING TIME

    12. Finish time:

    • Counting of all surgical instruments and sent to the sterilization center


    • Registration in the surgical instrumentation sheet
    • Filling in the drive all medical devices used in surgery
    • Put all devices back in the warehouse and clean surgical tables
    GRACIAS

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