Circuit Surfers

The Currents, Eddys & Riptides- of Open-Heart Surgery

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Activated Clotting Time (ACT)

Activated Clotting Time (ACT) The ACT is a standardized measurement of the patients procoagulation or anticoagulation level.  The unit of measurement is the time (in seconds) that is required for an ACT counter to detect the formation of blood clot in a 2-3 milliliter sample of whole blood.  Normal ACT levels range from 100-130 seconds,…

PTT|teg|Sono|fib LYSIS

Hemostasis Assays [v.1]

Partial Thromboplastin Time (Activated) The activated partial thromboplastin time (aPTT) is test that overlaps the prothrombin time (both evaluate the common pathway), and is designed to isolate the intrinsic pathway.  While these tests are similar, the aPTT utilizes kaolin or cellite and cephaloplastin to stimulate the intrinsic pathway.  This pathway is the longer of the…

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Heparin (v.1)

HEPARIN   ONSET:   Maximal at 1 minute past atrial delivery: Measured at radial artery.  Note:  10-20% reduction in svr without affecting c.o. and or h.r.   LUNG VS MUCOSAL:   Mucosal requires larger doses- but can be reversed with 25-30% less protamine:  greater postoperative blood loss associated with mucosal heparin- speculated to result from…

fib-lysis1|Fibrinolysis 2|HIT


Fibrinolysis Fibrinolysis is the dissolution of the clot formation process involving the plasma protein plasminogen.  This system of enzymes dissolves blood clots by the lysis of fibrin.  Fibrinolysis plays a role as well in other biological processes such as tissue repair, macrophage activation and function, ovulation, and embryo implantation.  Fibrinolysis is mediated by plasmin and…


Coagulation Cascade (V.1)

  Intrinsic Pathway The coagulation cascade is initiated when blood becomes traumatized by exposure to a foreign surface.  An example of this is the initiation of cardiopulmonary bypass.  Blood contact with the polyvinyl chloride tubing utilized in the extracorporeal circuit, the squeezing mechanism of the roller head pump, and various applications of blood filtering devices,…

TOS Cover Tag

Excerpts: So… You Want to Transport an ECMO Huh?

Editor’s Note: This book is NOW over 99% written and moving into the Editing Phase! The title of the book is “The Tips of Spears- An Inside Look At Heart Surgery in America” It is a rendering of the reality, sometimes sad and at times funny, emotional, and clinical vignettes of the many different aspects…