R E-DO

2005

... 6... 7... 7... 7... 8... 8... 8... 9... 9...10...10...10...10...11...11...17...19... 20...20...20...20 R E-DO...21...21...21...22...22...22...23...23... 24 2

ICU...24...24...24...24...25...26...26...26...27...27...27 C4... 28...28...29...30...31... 32...32...32...33...33... 34...34...35... 36...36...36...36... 41...41...41 3

...41...41...42...42...44 HDF... 45...45...45...45...45...46...47...47... 48...48...49...50... 52...52...53...53 IABP (PCPS)...54...54...54...55...56...56...56 PCPS... 57...57 PCPS...58 PCPS...58 4

PCPS...60 ECLA... 61...61 V-V ECLA...62 PCPS...62 ECLA...63 ECLA...63... 64...64...67 DPC... 70...70...70... 71...71...73 CCS... 77 NYHA... 77... 78...78...78... 79 5

7:30 8:00 8:30 ICU ICU ICU ICU ICU ICU 9:00 Ope 2 ) Ope 1 Ope 1 Ope C4 10:00 C4 C4 C4 C4 C4 16:30 18:00 C4 C4 ICU ICU ICU C4 10:00 C4 X-p 6

C4 1. 2. 3. 7

LMT NYHA 3 AS (VT,Vf C4 VAIO-JX CABG CABG + [Valve or TAA] CABG Valve ( AVR MVR MVP Bentall ) Valve + CABG Valve + TAA ASD TAA (+ other) TAA 8

CABG ( ) free LMT 75% free LMT 90% 1 NYHA free NYHA free NYHA (100 NYHA Ns BB ( ) SP 9

B DM 1400 kcal or 1200 kcal P70 (or P60) C4 Vital ( ) Vital 1 Vital 3 BS ( ) BS ( ) 10

ICU 1. HIV : HBV HCV STS HIV TSH FT 3 FT 4 2. ANP BNP 3. : R L : 4. LMT NYHA 3 AS 5. 11

6. 7. 8. 9. 3 MRSA MRSA MRSA 10. 1.0 1 12

1. HbA 1 C 75gOGTT 2. room air MRI MRA CT MRI MRA CT Dr CABG AS MR (Aneurysm Dyskinesis) 5590 13

(PHS: 070-6507-4886) CABG ATP RI (PHS: 070-6507-4886) 14

C4 VAIO JX [ coronary disease ] [ valvular disease and others ] print out VAIO ICU 2 ID ICU ICU CABG + Dor + MVP 15

81mg severe ASO 6 risk factor MRA MRI 16

CT Ope Ht 30% 800cc 2T H.S. 400cc 500cc drip 20mmHg 24000 LMT ( 90 % ) CCS NYHA AS 15mm Ht 35% 80 BS 140mg/dl 17

16 MDCT (PHS: 070-6507-4950) Cr 1.5mg/dl CCr 30ml/min HDF 18

18 00? 19

1g 30 100ml SIRS 1g 1g 1g 2g 3g ICU CABG Off-Pump On-Pump Beating Off-Pump conversion Conventional CABG Valve Closed Circuit Closed Circuit Open Circuit Open Circuit CABG + Valve or Others(Dor etc) Open Circuit ME 1300ml Ht < 40 % Alb 4.0 mg/dl 500ml 25% albmin 2vial Ht < 35 % MAP 4u + 25% albmin 2vial 20

Re-do Pump PCPS 8mm DC pacing HDF ( Cr 1.5mg/dl CCr 30ml/min ) CRF on HD HDF 0.05 21

3-5 ME On Pump Beating Bypass Vf ASD closure A KCL Mg 500 ml 10 ml 8 meq ( 4 ml ) 7 ml CABG - - DV S-VHS ME 22

EPSON Balance Sheet (ME ) 2kg 400 25% 1vial 5% 1vial FFP 2 Ht< 23% Ht 30-35 % MAP 4 /mm 3 /mm 3 23

ICU SVO 2 ICU ICU - Excel File ICU 70 23 2ml/kg/hr 24

2 1 H.S. Ht > 35% (8) 1T (20) 2T 2 A(25) 2T 2 50kg 50kg 3mg 2mg PT INR CABG On Pump Off Pump Radial A. GEA 1T 2T (25)3T 3 (100) 2 50kg SVG 50kg 3mg 2mg PT INR Off Pump CABG HD APTT APTT 3.5 0.3 7500 2 9 21 7 25

1A im 25 2 200 37 Cooling 38.5 Dr call 1A im 6 CABG Valve 500ml/day 1000ml/day 26

200ml/day 70ml / 8hr Swan-Ganz Cath. CV line A line 27

C4 1, 2, 3, 4, 6, 8, 10, 12 (ICU ) P A A P PT INR ( PTINR 1.5 ) APTT Off Pump CABG [ ] 28

C4 C4 PTINR POD3 POD3 38.5 POD7 POD 3-10 POD 11-17 1g / 100ml div 0.5g / 100ml div 2 /day 2 /day 29

CABG PHS: 070-6507-4886 (PHS: 070-6507-4886) C4 CT CD-ROM Xp EKG HOPE/EMAIN-EX 30

PTINR Pro 5.5 ( for Windows) MO 31

BS4 + 230mg/dl (RI: 1cc= 1u) BS (mg/dl) - 70 RI ( ml/hr ) RI Off 20% Tz 2A div (5 min ) Dr Call 71-140 RI Off 141-180 0.3 181-220 0.5 221-260 0.8 261-300 1 301-350 1.5 351-400 2 2hr 401-450 3 2hr 451-499 4 2hr 500 - Dr Call 32

consult ~ 150 ~200 ~250 ~300 ~350 351~ mg/dl 50kg 0 2 4 6 8 10 ( ) 50kg 0 4 6 8 10 12 70mg/dl 20% 2A iv Dr call 500mg/dl 500ml / 2hr Dr call 33

CABG ECG( ECG(12 Bentall David Full Root Root Replacement ECG( ) ECG(12 ) ASD Valve & Others ECG( ECG(12 ) 34

ECG ECG Dr call 1 ECG 30mmHg 20mmHg 120/min 40/min ST 0.1mV ST 0.2mV 80msec PAC PVC sinus rhythm Af VT ) 35

6 6 5 4 3 2 5mg 3mg 2mg 1mg 0mg 0mg 0mg 4mg 2mg 1mg 0mg 0mg 0mg 0mg 3mg 2mg 1mg 0mg 0mg 0mg 0mg 2mg 1mg 0.5mg 0mg 0mg 0mg 0mg [ ] + LMT 90% (LAD & Cx etc) 1 36

2cc (2000 U) 200 / kg / day APTT 1.5-2.5 10cc + 40cc APTT ( ) APTT (kg) (ml / hr) APTT (ml / hr ) - 50 2.0 51-60 2.5 61-70 2.8 71-3.0-1.2 + 0.5 1.3-1.4 + 0.2 1.5-2.5 0 2.6-3.0-0.2 3.1-3.5-0.5 3.6 - Off Off APTT Off APTT (ml / hr ) - 1.4-0.2 1.5-2.5-0.5 2.6-3.5 Off 3.6-1cc iv 20 37

[ ] LAD 50mm severe 5cm 9 21 APTT ( 33-38 ) 1.5-2.5 11 30 APTT ( kg ) ( ml ) ( ml ) - 50 10.000 0.4 5.000 0.2 51-65 15.000 0.6 7.500 0.3 66-20.000 0.8 10.000 0.4 APTT - 1.2 +5.000 (0.2ml) 1.3-1.4 +2.500 (0.1ml) 1.5-2.5 0 ( 0 ml) 2.6-3.0-2.500 (0.1 ml) 3.1-3.5-5.000 (0.2 ml) 3.6-1 Off 7.500 (0.3 ml) 38

15.000 (0.6ml) / ( ) 2.500 0.1ml / APTT Power On [SELF TEST] [INSERT CARTRIDGE] [SELECT SAMPLE TYPE] [ PATIENT ] [ CARTRIGE HEATING ] 60 0.2ml [APPLY SAMPLE] 0.1ml i-stat [ ENT ] [ ENT ] [PRINT] 39

C4 i-stat 40

HD ( ) HD ( ) HD HD ( ) ( Ope ) ICU HD ( or ICU) HD HD HD ENT ( ) ( ) ( ) Fax (50mg) 4vial HDF 41

ICU CV Swan-Ganz 20ml/hr line 5ml/hr ICU K + GI BUN 80 CHDF HD C4 ICU HD ICU HD 42

HDF HDF CHDF C.I. 2.5 L/min/ HDF HD CHDF Cr 1.5mg/dl CCr 30ml/min HDF 0.05-0.2 43

1000-2000cc Cr HDF HD 44

HDF 25mg/hr 200ml/min 0-1000ml/hr 1000-2000 ml/hr CVP(RAP) K + Ht C.I. 3-5 mmhg 3.0-3.5 meq/l 30 35% > 2.5L/min/m 2 CVP C.I. 45

Off Pump CABG HDF 4L 40-70ml/min HDF inflow HDF inflow HDF L MAP4u 25% 2vial MAP Ht <30% MAP Ht 30% 25 400 25% 1vial 5% 1vial FFP 2 EPSON Balance Sheet HD TP 6.0mg/dl Alb 3.5mg/dl 46

25% 2vial FFP 10 ACT FiO 2 40% PO 2 < 80mmHg PEEP PCWP MR C.I >3.0 L/min/m 2 PCWP 10mmHg PEEP 10cmH 2 O K + free 47

sinus rythm rate 70-100 bpm 1) sinus rythm (PAC Af PVC VT ) K+ heart rate overdrive pacing(a-pacing) PAC Af PVC VT 2% 2) rate A-pacing digoxin digoxin rate V( ) IABP Af AF rate control 48

RAP CVP or PCWP RAP( ) Volume up RAP Volume up Volume up capillaly leak syndrome RAP Ht (DOA NAD) ( ) (DOA DOB NAD BOS ) PDE ( etc) Ca( ) IABP PCPS ICU SIMV 49

2ml/kg/hr 1ml/kg/hr C.I. 2.5 ml/kg/ 20 /min PCO 2 60mmHg FiO 2 0% PO 2 100mmHg ( CABG ) 120-140/mmHg RAP 7-10mmHg ST-T (PMI) Volume up ( MVR or MVP ) 90-120/mmHg RAP 5-7mmHg RAP PAP 50

(AVR) AS AVR 120-140/ 60-80 mmhg RAP 3-7mmHg 90-120bpm 15mm IABP 4.2 K+ 4.7mEq/l PVC VT AR AVR 90-120/mmHg 70-90 bpm RAP 7-10mmHg ASD 90-120/mmHg RAP 3-5mmHg ST 51

SIRS (ADH) IL-8 SIRS 70,000/mm3 Ht 30-35% MAP ACT FFP 4u CVP(cmH 2 O) PEEP CABG 1 mmhg = 13.54( )mmh 2 O 1.354 cmh 2 O CVP(RA) 8mmHg 10.8 cmh 2 O 12-15 cmh 2 O PEEP PEEP C.I. PEEP 2ml/kg/hr ( 52

C.I. Ht (33-35 ) ICU C.I. (37 ) 36-37 25% 5% 53

C.I. CVP HD CHDF ECUM IABP (PCPS) IABP C.I.<2.2 PCPS PEEP BiPAP BiPAP 54

PCPS(V-A Bypass) PCPS SIRS ALI(Acute Lung Injury) 100% SaO 2 90% 2 24 FiO 2 80% PEEP 10cmH 2 O SaO 2 90% TRALI( ) ECLA ECLA 24 BIS 40-60 BIS 60-80 55

3 total 40 kcal/kg/day DIC FDP D- ACT 150-200 APTT 1.5-2.5 FOY FOY 56

PCPS PCPS FiO 2 50-70% PEEP 5-10 cmh O 5-10 ml/kg 4-8 /min CVP PCPS LVAD 60 kg 60 kg 13.5 F 15 F 16.5 F 19.5F 21 F 23 F Medtronic 60 kg 60 kg 15 F 17 F 21 F 23 F 57

PCPS PCPS cut down PCPS IVC Medtronic PCPS (19 or 21F) 20-30cm ASO 5F PCPS C.I. Swan-Ganz Cath. PCPS C.I. 2.5 ml/kg/ IABP 58

A-line SpO 2 PCPS Volume CVP 5-10mmHg 2200 1. FFP L/min flow 1-2 2. 3. Medtronic PCPS 15-25cm (34.5-35.5 ) 59

O 2 ACT (150-200 s ) PCPS PCPS V-V ECLA FiO 2 100% PCPS C.I. Swan-Ganz Cath. PCPS C.I. 1:2 SpO 2 PCPS PCPS CVP(RA) IABP C.I. Swan-Ganz Cath. PCPS C.I. 2.5 ml/kg/ PCPS PCPS ACT 200-300 s 60

ECLA (extracorporeal lung assist; ECLA) (extracorporeal membrane oxygenation; ECMO) PCPS FiO 2 60% PEEP ECLA Ht 35-40% MAP Medtronic PCPS 4cm PCPS 10 10 mm Medtronic 60 kg 60 kg 19 F 19 F or 15 F 17 F 21 F 23 F or 15 F 17 F 61

V-V ECLA Swan-Gantz Cath. SvO 2 in vivo calibration PCPS V-V ECLA 1. PCPS PCPS 20cm 2. Medtronic PCPS 20cm 16.5F PCPS 1-2 cm PCPS PCPS(V-A Bypass) V-V ECLA PCPS PCPS(V-A Bypass) V-V ECLA 62

PCPS 20cm V-V ECLA Medtronic PCPS 20-25cm PCPS 30cm ECLA Swan-Ganz Cath. SvO 2 ECLA ECLA SV E O 2 Swan-Gantz Cath. SV P O 2 ECLA SV P O 2 - SV E O 2 SaO 2 - SV P O 2 SaO 2 93-95 % ECLA PCPS 3L/min ECLA ECLA ECLA 63

140-200 PN DIC 5ml/hr (20%) 200 ml 200ml 40g (400 kcal) 1 1kg 2g 1A 1A (20)1A 1A 64

(20)1A 70 ml/hr ( 1320 kcal /day / 142 ) 2 1A 1A (20)1A 1A 2 (20)1A 75 ml/hr ( 1640 kcal /day / 149 ) 1 1A 1A 1A Fischer Na 10% NaCl 2 700 ml 400 ml 1A 1A 1A 1A 1A (20)1A 1A 10% NaCl 2A 45ml/hr ( 700 kcal /day / 143 ) 65

3 700 ml 400 ml 1A 1A 1A 1A 1A (20)1A 1A 10% NaCl 2A 45ml/hr (1000 kcal /day / 204 ) 3 700 ml 400 ml 1A 1A 1A 1A 1A (20)1A 1A 10% NaCl 2A 3 700 ml 400 ml (20)1A 90ml/hr (2000 kcal /day / 204 ) K+ free 200 CHDF 1 RF 500ml 300ml 1A 1A 1A 1A 32 ml/hr ( 1000 kcal /day / 333 ) 66

bacterial translocation ST ED ICU 8-12F ED (80-100cm) ST (14-18F) ST 500 ml/day ED 60ml ST 1cc = 1kcal (300mOsm/kgH 2 O) 60ml ED 67

5% 10 ml/hr 20 ml/hr 40g / 300cc ( 1cc = 0.5 kcal ) 20 ml/hr 40 ml/hr 80g / 300cc ( 1cc = 1 60 ml/hr 1500kcal/day kcal ) 40 ml/hr ST ED 16 F2 ED ED ST 1-2 ST 68

; Percutaneous Endoscopic Gastrostomy ED tube 69

DPC DPC DPC DPC 70

1. ( ICU ) 2. (DPC) DPC 3. 4. 5. 6. MRSA 71

TSH ft 3 ft 4 3 75g OGTT 3 HbA1 C 800 72

ICU ICU 2 H 2 blocker CABG On Off Pump Pump 73

PGE1 MAP 74

FOY DIC PTINR MRSA MRSA MRSA 75

TTS 76

CCS 1 NYHA 77

ECG SaO 2 free 1 Ccr free 1 Ccr free 1 Ccr 3 3 1 ECG SaO 2 free 1 Ccr free 1 Ccr free 1 Ccr 3 3 1 78

MAP FFP PLT + 0 6 0 0 80 0 10 6 0-80 4 6 6 0 + 0 10 6 0 re Ope 80 4 10 10 0-80 6 14 10 20 79

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