Arrow International Inc - Educational Materials

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Question 1.

The following strip was recorded from a patient post CABG. He had atrial and ventricular temporary pacing wires inserted during surgery.

A. What is wrong with the pacemaker?

	a.	The connections to the atrial and ventricular wires are reversed so that the ventricles are being paced first then the atria.
	b.	The pacemaker is functioning correctly.
	c.	The pacer is not sensing appropriately.
	d.	The pacer is not capturing.
	e.	The patient is not paced at this time.

B. Would you want to go to OPERATOR mode and select V Pace as the trigger mode?

	a.	Yes.
	b.	No. The second pacer spike (the potential trigger event) is after the QRS complex so timing could be an issue.

Question 2.

What is wrong with the arterial pressure line on the following strip?

	a.	AP line is dampened and needs to be flushed.
	b.	Transducer needs to be zero'd.
	c.	The IAB is too high and the tip of the arterial line is being occluded as it hits up against the aortic arch.
	d.	Nothing.
	e.	There is air in the pressure tubing.

Question 3.

You are turning your patient when the pump suddenly alarms GAS LOSS and prints the following strip.

What is the problem?

a. The balloon has ruptured.
b. The gas tubing connection has become loose.
c. The balloon kinked during the turn.
d. The pump is low on helium.
e. There was a loss of trigger.

Question 4.

The pump is in AUTOPILOT mode.

A. Assess the timing on the following strip.

a. Late inflation and correct deflation
b. Early inflation and correct deflation
c. Early inflation and early deflation
d. Correct inflation and late deflation
e. Late inflation and early deflation

B. Should you leave the pump in AUTOPILOT mode?

a. Yes.
b. No. Go the OPERATOR mode so that you can correctly time the pump.

Question 5.

Is this a timing or a triggering problem?

a. Timing problem
b. Trigger problem

Question 6.

The pump is in AUTOPILOT mode. There is a message AP TRIGGER ACTIVE on the screen. You know that ECG is the preferred trigger mode so you place the pump in OPERATOR mode so that you can change the trigger. But when you select ECG trigger pumping is erratic a there is a message ARRHYTHMIA on the screen. So you go back to AP trigger.

A. While the pump is in OPERATOR mode you notice that the arterial pressure trace looks different from when it was in AUTOPILOT. Assess the timing.

a. Late inflation and early deflation
b. Correct inflation and early deflation
c. Early inflation and late deflation
d. Late inflation and late deflation
e. Early inflation and early deflation

B. The patient is 100% AV paced. Why would the message ARRHYTHMIA be displayed on the screen when the pump was in ECG trigger?

a. The pump is triggering on both pacer spikes.
b. The patient is having ectopic beats.
c. The pacer is intermittently capturing.
d. The ECG is noisy.
e. Internal trigger should be used.

Question 7.
The following patient is in Cardiogenic Shock. A 40cc IAB was inserted yesterday. It is in the correct position per CXR. He is 6'4" and 131.5kg. His HR is 146, CI is 1.3, PCWP is 28 and SVR is 433. He is on Dobutrex at 20mcg/kg/min, Primacor at 20mcg/kg/min, Dopamine at 15mcg/kg/min, Levophed at 101mcg/kg/min and Heparin at 1000u/hr.

Why is diastolic augmentation less than systole?

	a.	There is a timing error.
	b.	He is dry and needs more volume.
	c.	His cardiac status is so poor that an IABP cannot provide adequate support and a VAD should be considered.
	d.	The IABP is mal functioning.
	e.	The sun is shining and the patient would rather be outside.

Question 8.

A. Assess the timing on the following strip.

a. Early inflation and early deflation
b. Late inflation and late deflation
c. Correct inflation and late deflation
d. Late inflation and early deflation
e. Correct timing

B. Why does the timing look different on the first beat on the strip?

	a.	Some one was changing the timing.
	b.	The amplitude of that R wave was too small to be recognized and the pump triggered on the T wave.
	c.	The patient is being paced.
	d.	The arterial line is the problem.
	e.	It was an ectopic beat.

Question 9.

Assess the timing on the following strip.

a. Correct timing
b. Early inflation and late deflation
c. Early inflation and early deflation
d. Correct inflation and early deflation
e. Late inflation and early deflation

Question 10.

Assess the timing on the following strip.

a. Correct timing
b. Late inflation and correct deflation
c. Early inflation and late deflation
d. Late inflation and early deflation
e. Correct inflation and early deflation

Caution: U.S. Federal Law limits these devices to sale by or on order of a physician. Contents of unopened, undamaged package are sterile. Disposable. Refer to package insert for current warnings, indications, contraindications, precautions, and instructions for use.