Anatomy Chapter 1: Circulatory System
42 Questions
2 Views

Choose a study mode

Play Quiz
Study Flashcards
Spaced Repetition
Chat to lesson

Podcast

Play an AI-generated podcast conversation about this lesson

Questions and Answers

How many miles of blood vessels does the average adult human contain?

  • Over 50,000 miles
  • Over 60,000 miles (correct)
  • Over 80,000 miles
  • Over 70,000 miles

    • The heart is cone-shaped and found between the lungs in the middle of the chest.

    True

    What is the weight range of the heart of the average male?

    280-340 grams

    The heart has a protective covering called the ____________.

    <p>pericardium</p> Signup and view all the answers

    Match the following heart chambers with their descriptions:

    <p>Right atrium = Small chamber used for venous cannulation Right ventricle = Lower chamber of the right heart, forces blood through the pulmonary valve Left atrium = Receives oxygenated blood from the lungs Left ventricle = Most powerful chamber with a thick wall, contracts to send blood into the aorta</p> Signup and view all the answers

    Which vein runs up the inner aspect of the thigh with the femoral artery?

    <p>femoral vein</p> Signup and view all the answers

    Where does the lesser saphenous vein begin?

    <p>Outer foot arch</p> Signup and view all the answers

    Blood gases are routinely performed on CPB to ensure proper oxygenation, carbon dioxide level and pH status.

    <p>True</p> Signup and view all the answers

    The greater saphenous vein is harvested for use as conduit during coronary bypass artery ________.

    <p>grafting</p> Signup and view all the answers

    What is the function of the coronary sinus?

    <p>To allow blood from the superficial veins to enter the right atrium.</p> Signup and view all the answers

    Which arteries contain 3 layers of tissue?

    <p>Arteries</p> Signup and view all the answers

    Veins contain valves to prevent backflow of blood. Is this statement true?

    <p>True</p> Signup and view all the answers

    The dorsal metatarsal artery runs along the __________ aspect of the foot.

    <p>outer</p> Signup and view all the answers

    Match the following arteries with their corresponding veins:

    <p>Axillary artery = Axillary vein Radial artery = Radial vein Hepatic artery = Hepatic vein Inferior mesenteric artery = Inferior mesenteric vein</p> Signup and view all the answers

    What are the two main causes of acidosis?

    <p>Respiratory factor and metabolic factor</p> Signup and view all the answers

    What is another term for increased CO2 condition?

    <p>Hypercarbia</p> Signup and view all the answers

    Metabolic acidosis occurs when the lungs are unable to remove sufficient CO2.

    <p>False</p> Signup and view all the answers

    The addition of large amounts of IV solution with a low pH may cause a lower pH, such as Lactated Ringer's Solution with a pH of __.

    <p>6.2</p> Signup and view all the answers

    Match the corrective action with the corresponding condition:

    1. Increase sweep gas to blow off more CO2
    2. Ensure adequate tissue perfusion and give sodium bicarbonate
    3. Decrease sweep gas to blow off less CO2

    <p>Corrective Action for Respiratory Alkalosis = Decrease sweep gas to blow off less CO2 Corrective Action for Metabolic Acidosis = Ensure adequate tissue perfusion and give sodium bicarbonate Corrective Action for Respiratory Acidosis = Increase sweep gas to blow off more CO2</p> Signup and view all the answers

    What is the normal pulmonary artery pressure?

    <p>25/8 mmHg</p> Signup and view all the answers

    Post-CPB, pulmonary artery pressures are usually decreased.

    <p>False</p> Signup and view all the answers

    What is considered a proper mean systemic arterial pressure range?

    <p>60-90 mmHg</p> Signup and view all the answers

    What kind of drugs are catecholamines that are secreted by the adrenal medulla?

    <p>epinephrine and norepinephrine</p> Signup and view all the answers

    Good renal function is an indicator of the adequacy of ________.

    <p>perfusion</p> Signup and view all the answers

    What is the predicted hematocrit of the 75 kg patient on bypass with a circuit priming volume of 2200 ml?

    <p>21.1%</p> Signup and view all the answers

    How many packed RBCs would be needed to achieve a hematocrit of 25% for the same patient?

    <p>287.5</p> Signup and view all the answers

    What is the new hematocrit after adding 500 ml of crystalloid solution?

    <p>23%</p> Signup and view all the answers

    What is the new hematocrit after adding 350 ml of packed RBCs?

    <p>25%</p> Signup and view all the answers

    Which factor can cause poor venous return during bypass?

    <p>All of the above</p> Signup and view all the answers

    What temperature are myocardial temperatures kept below?

    <p>15° C</p> Signup and view all the answers

    What temperature range is a warm dose of cardioplegia typically given just prior to crossclamp removal?

    <p>36-38° C</p> Signup and view all the answers

    Cardiac muscle is made of fibers that contain the sarcomere, which is the main functioning component of smooth muscle.

    <p>False</p> Signup and view all the answers

    Cardiac muscle can be distinguished from both skeletal and smooth muscle in that it is ______.

    <p>striated</p> Signup and view all the answers

    Match the following components with their roles in cardiac muscle:

    <p>Endomysium = Composition of fibroblasts, collagen, and capillaries Sarcomere = Main functioning component of striated muscle Calcium = Necessary for muscle contractions Myocardium = Thick muscular layer of the heart</p> Signup and view all the answers

    What may happen if the line pressure of the cardioplegia infusion decreases in conjunction with the decrease in arterial pressure?

    <p>Cardioplegia enters the systemic circulation</p> Signup and view all the answers

    What could be the cause of inappropriate washout when using cardioplegia?

    <p>Venous cannula not allowing venous drainage of the heart</p> Signup and view all the answers

    True or False: Pinching of the crystalloid line could greatly decrease the amount of potassium infused.

    <p>True</p> Signup and view all the answers

    What electrolyte is included in the solution to effect electrical neutrality?

    <p>Chloride</p> Signup and view all the answers

    How is cellular edema decreased in solutions?

    <p>By having a slightly hyperosmolar solution</p> Signup and view all the answers

    Excessive hyperosmolarity would cause cellular dehydration.

    <p>True</p> Signup and view all the answers

    Potassium contributes to electromechanical arrest in cardioplegia solutions, while ________ prevents edema and intracellular calcium buildup.

    <p>Sodium</p> Signup and view all the answers

    Match the ingredient with its action in cardioplegia solutions:

    <p>Potassium = Electromechanical arrest Sodium = Prevents edema and intracellular calcium buildup Calcium = Membrane stabilization and prevents intracellular calcium buildup Bicarbonate = Increases pH Tromethamine = Increases pH Glucose = Increases osmolarity to prevent edema, also a substrate Mannitol = Increases osmolarity to prevent edema</p> Signup and view all the answers

    Study Notes

    Anatomy of the Heart

    • The heart is a cone-shaped organ located in the middle of the chest, between the lungs, in the middle mediastinum.
    • The heart has four chambers: right and left atria, and right and left ventricles.
    • The heart has four one-way valves to direct blood flow through the chambers.
    • The upper chambers, the right and left atria, are divided by the atrial septum.
    • The lower chambers, the right and left ventricles, are divided by the ventricular septum.

    Heart Walls

    • The heart has a protective covering called the pericardium, which allows the heart to move with minimal friction.
    • The pericardium has two layers: the fibrous layer and the serous pericardium.
    • The serous pericardium is further divided into the parietal and visceral layers.
    • There are three layers of the heart wall: epicardium, myocardium, and endocardium.

    Right Heart

    • The right heart receives deoxygenated blood from the upper body through the superior vena cava and from the lower body through the inferior vena cava.
    • The right atrium is the site of venous cannulation for cardiopulmonary bypass (CPB).
    • The blood moves from the right atrium through the tricuspid valve into the right ventricle.
    • The right ventricle pumps blood through the pulmonary valve into the pulmonary artery.

    Left Heart

    • The left heart receives oxygenated blood from the lungs through four pulmonary veins.
    • The left atrium is slightly larger than the right atrium.
    • The blood moves from the left atrium through the mitral valve into the left ventricle.
    • The left ventricle pumps blood through the aortic valve into the aorta.

    Coronary Arteries

    • The coronary arteries supply oxygenated blood to the heart muscle.
    • The coronary arteries come from the aorta and branch into smaller arteries.
    • The left main coronary artery supplies the myocardium of the left ventricle.
    • The right coronary artery supplies the myocardium of the right ventricle.

    Coronary Veins

    • The coronary sinus system and the anterior cardiac system make up the venous drainage of the heart.
    • The coronary sinus is a large vessel that allows blood from the superficial veins to enter the right atrium.
    • The coronary veins mirror the coronary arteries to some extent.

    Arteries and Veins

    • Arteries are muscular, elastic tubes that carry oxygenated blood away from the heart.
    • Veins are thin-walled, low-pressure vessels that carry deoxygenated blood back to the heart.
    • Arteries have three layers: intima, media, and adventitia.
    • Veins have valves that prevent backflow of blood.

    Aortic Arch Vessels

    • The aortic arch is the curved part of the aorta that gives rise to the innominate, left common carotid, and left subclavian arteries.
    • The innominate artery divides into the right carotid and right subclavian arteries.
    • The left common carotid artery supplies the brain and eyes.
    • The left subclavian artery supplies the left arm and hand.

    Arteries of the Upper and Lower Extremities

    • The subclavian artery supplies the upper extremity.
    • The axillary artery becomes the brachial artery in the upper arm.
    • The brachial artery divides into the radial and ulnar arteries.
    • The radial and ulnar arteries supply the arm and hand.
    • The abdominal aorta gives rise to the celiac, mesenteric, and renal arteries.
    • The renal arteries supply the kidneys.
    • The abdominal aorta bifurcates to form the right and left common iliac arteries.
    • The common iliac arteries divide into the internal and external iliac arteries.
    • The external iliac artery becomes the femoral artery at the inguinal ligament.
    • The femoral artery supplies the leg.
    • The popliteal artery divides into the peroneal, anterior, and posterior tibial arteries.
    • The anterior and posterior tibial arteries supply the lower leg and foot.### Venous System
    • The venous system parallels the arterial system in structure and function
    • Veins return blood to the heart through the superior and inferior vena cavae
    • The blood then passes through the right atrium, ventricle, and pulmonary artery to the lungs
    • In the lungs, oxygen is absorbed, and carbon dioxide is removed
    • The oxygen-rich blood returns to the left heart and enters the arterial system

    Veins of the Head

    • Veins of the brain drain into the venous sinuses of the brain
    • The sagittal and transverse sinus veins drain the veins of the brain
    • Diploic veins connect the veins outside the skull to the sinuses inside the skull
    • The venous blood from the head enters the external and internal jugular veins
    • The external jugular vein is the largest vein in the neck and drains the face and scalp
    • The internal jugular vein runs alongside the carotid artery on both sides of the neck

    Veins of the Upper Extremities

    • The upper extremities have deep and superficial veins
    • The subclavian vein drains the axillary vein from the arm
    • The brachial and basilic veins combine to drain into the axillary vein
    • The cephalic vein runs in the arm up to the shoulder and drains into the subclavian vein
    • Fingers are drained by digital veins that converge into the palmar arch
    • The palmar arch joins with the radial vein that runs alongside the radial artery

    Large Veins

    • The gastroepiploic veins drain the stomach and enter the inferior vena cava
    • The splenic vein is formed from five or six branches that return blood from the spleen
    • The splenic vein and mesenteric veins combine to form the portal vein
    • The superior and inferior mesenteric veins drain the small intestine and colon, respectively
    • The renal veins empty into the inferior vena cava

    Veins of the Lower Extremities

    • The lower extremities are drained by superficial and deep veins
    • The superficial veins include the greater and lesser saphenous veins
    • The deep veins include the femoral and popliteal veins
    • The femoral vein runs up the inner thigh alongside the femoral artery
    • The popliteal vein receives blood from the anterior and posterior tibial veins

    Blood Gases

    • Blood gases are used to assess oxygenation and acid-base status
    • Oxygen content, capacity, and consumption are dependent on hemoglobin
    • The hemoglobin oxygen dissociation curve represents the relationship between hemoglobin and oxygen in the blood
    • Shifts in the curve reflect changes in oxygen affinity
    • P50 is a reflection of the enzyme effect on hemoglobin affinity for oxygen
    • Oxygen calculations include formulas for oxygen carrying capacity, content, and saturation

    Carbon Dioxide

    • The arterial pCO2 affects the pH of the blood
    • Carbon dioxide is transported by hemoglobin and dissolved in the plasma
    • The Bohr effect describes the release of oxygen from hemoglobin in response to increased CO2
    • The Haldane effect describes the release of CO2 from hemoglobin in response to increased O2

    pH

    • pH indicates the blood's acidity or basicity
    • Normal pH range is 7.35-7.45
    • Acidosis is present when the pH is below 7.35, and alkalosis is present when the pH is above 7.45
    • Buffer systems resist changes in pH
    • The bicarbonate system is the major buffer system in the body
    • The kidneys play a role in regulating pH through the excretion of bicarbonate ions

    Acid-Base Balance

    • Acidosis can be caused by respiratory or metabolic factors
    • Respiratory acidosis is caused by too little CO2 being removed from the lungs
    • Metabolic acidosis is caused by inadequate oxygenation of the tissues
    • Alkalosis is caused by excessive removal of CO2 or excessive administration of alkaline solutions
    • Correction of acidosis or alkalosis may involve administering sodium bicarbonate or adjusting ventilatory support### Blood Gases
    • Signs of shunting:
      • High venous pO2
      • Low systemic arterial blood pressure
      • Decreased A-V pO2 difference
    • Atmospheric gases at sea level:
      • Oxygen: 20.84% of total, 159 mmHg partial pressure
      • Nitrogen: 78.62% of total, 597 mmHg partial pressure
      • Carbon dioxide: 0.04% of total, 15 mmHg partial pressure
      • Water: 5% of total, 385 mmHg partial pressure
    • Alveolar air:
      • Oxygen: 13.6% of total, 104 mmHg partial pressure
      • Nitrogen: 74.9% of total, 569 mmHg partial pressure
      • Carbon dioxide: 5.3% of total, 40 mmHg partial pressure
      • Water: 6.2% of total, 47 mmHg partial pressure

    Corrective Actions for Abnormal Blood Gas Results

    • Respiratory alkalosis:
      • Corrective action: Decrease sweep gas, raise pO2 by increasing FIO2 percentage
      • Increase pump flow to expose more blood to oxygen or cool slightly
    • Respiratory acidosis:
      • Corrective action: Increase sweep gas, raise pO2 by increasing FIO2 or increasing blood flow
    • Metabolic acidosis:
      • Corrective action: Ensure adequate tissue perfusion, give sodium bicarbonate

    Alpha-Stat and pH-Stat

    • Alpha-stat and pH-stat are methods of calculating blood gas values
    • pH-stat method: values are corrected for blood temperature
    • Alpha-stat method: values are not temperature corrected

    Conduct of Perfusion

    • Pre-bypass:
      • Review procedure and patient's chart
      • Calculate necessary blood flow and determine if blood or other products are needed
      • Prime the pump and determine cannula sizes
      • Consult with surgeon regarding cannula sizes
    • Predicted hematocrits:
      • Calculate the hematocrit that will result from the dilution of the volume used in priming the CPB oxygenator and circuit
    • Pre-bypass checklist:
      • Review patient's chart and procedure
      • Check oxygenator holder, pump circuit tubing, and Luer connections
      • Check gas lines, oxygen supply, and purge lines
      • Check power cords, backup power, and handcranks
      • Check water lines, temperature probes, and level detector
      • Check bubble detector, pressure warning devices, and in-line sensors

    Initiation of Bypass

    • Heparin administration:
      • Administered by surgeon or anesthesiologist
      • ACT started to determine adequate anticoagulation
    • Cannulation:
      • Place cannulae with purse string sutures
      • Test transfusion through arterial cannula
    • Initiation of bypass:
      • Start oxygen flow and remove arterial clamp
      • Begin pump flow slowly and observe arterial line pressure
      • Check for any obstructions or cannula malfunction
    • Checks after bypass is initiated:
      • Blood flow at proper rate
      • Arterial line pressure is normal
      • Oxygen started at proper flow and concentration
      • Oxygen saturations normal
      • Patient's arterial pressure 50-90 mmHg
      • Temperature appropriate
      • Coagulation status acceptable
      • Vaporizer turned on at appropriate level

    Studying That Suits You

    Use AI to generate personalized quizzes and flashcards to suit your learning preferences.

    Quiz Team

    Description

    Learn about the circulatory system, its functions, and the importance of oxygen and nutrient supply to the body's cells. Discover how the circulatory system transports life-giving oxygen and removes waste products.

    More Like This

    Use Quizgecko on...
    Browser
    Open
    Browser
    Browser