Advanced Hemodynamics

Question 1

Types of shock

Answer 1

Obstructive, Cardiogenic, Distributive, Hypovolemic, Neurogenic(a form of distributive), and Dissociative

Question 2

Obstructive shock

Answer 2

Ex: Cardiac Tamponade, Tension Pneumothorax, PE, and Congenital heart defects

Question 3

Cardiogenic shock

Answer 3

LV dysfunction(systolic and diastolic failure)

Question 4

Distributive shock

Answer 4

Ex: Septic, anaphylactic, and neurogenic

Question 5

Hypovolemic shock

Answer 5

Ex: Hemorrhagic, Volume loss, and Burn

Question 6

Neurogenic Shock

Answer 6

Spinal cord transection

Question 7

Dissociative Shock

Answer 7

Ex: CO poisoning, Methemoglobinemia, and Toxic metabolites

Question 8

Phlebostatic axis

Answer 8

Mid-point between the anterior/posterior chest in the 4th inter-costal space(tape the transducer at this point)

Question 9

Damping

Answer 9

Is the test to see how sensitive an arterial line pressures are

Question 10

Central Venous Catheters

Answer 10

> Flexible catheters that terminate in the superior vena cava
Can have single, dual, multiple ports
usually placed in the subclavian, external jugular, femoral, or AC veins.
can draw blood from them, give blood/fluids, give meds, and give IV food(parental nutrition)

Question 11

Swan-Gans catheter

Answer 11

> AKA the pulmonary artery catheter
at minimum, 3 ports with one being a balloon port.
Red and Yellow ports are potentially DEADLY ports! DO NOT TOUCH!!!
Red=balloon port, yellow=distal or thermistor port
Placed into vena cava through IJ, subclavian, or femoral vein.

Question 12

SVR equation and normal range
(Systemic Vascular Resistance)

Answer 12

SVR=[MAP-CVP/Q]x80

Normal 800-1200 dynes/sec/cm-5

Question 13

PVR equation and range
(Pulmonary Vascular Resistance)

Answer 13

PVR=[Mean PAP/Q]-PCWP x 80

Normal= 100-200 dynes/sec/cm-5

Question 14

Cardiac Output(Q)

Answer 14

Q=(SVR-HR)/1000

Normal = 4-8L/min

Question 15

Cardiac Index(CI)

Answer 15

Q/BSA

Normal 2-4L/min

Body Surface Area(average is 1.7m2

Question 16

Numeric values for PA catheter

Answer 16

Central Venous Pressure(CVP or RAP) = 2-6mmHg
RV systolic = 20-30mmHg
RV diastolic = 0-5mmHg
PA systolic = 15-25mmHg
PA diastolic = 8-15mmHg(important)**
Wedge pressure = 8-12mmHg
(Pulmonary capillary wedge pressure) also seen as PCWP or PAOP

Question 17

Central Venous Pressure

Answer 17

Used to monitor blood volume, central venous return or RV function, and administration of IV meds, fluids, blood, or TPN.

Question 18

Abnormal RAP/CVP causes

Answer 18

> Decreased CVP- right atrial pressures, hypovolemia, or vasodilation.
Increased CVP- RV failure/infarct, tricuspid insufficiency, or COPD.
Left sided failure- left systolic failure, volume overload, pulmonary HTN, cardiac tamponade, or PEEP.

Question 19

Abnormal RVP causes

Answer 19

> Increased RVP- RV failure/chronic CHF, pulmonary HTN/hypoxemia, or cardiac tamponade
not monitored except during PA catheter placement, not monitored during transport

Question 20

Pulmonary Artery pressure(PAP)

Answer 20

Uses: measure PA systolic pressure(PAS), PA diastolic pressure(PAD), and indirectly reflects LV end-diastolic pressure.

PAD Can be used to estimate wedge pressure- 2-4mmHg higher than mean wedge pressure

Question 21

Abnormal PAP/PCWP causes

Answer 21

> Decreased PAP: hypovolemia and dampened waveform
Increased PAP: fluid overload, atrial or ventricular defect, pulmonary problems(COPD or Asthma, mitral valve regurgitation/stenosis, or LV failure

Question 22

Anacrotic notch vs dicrotic notch

Answer 22

(PA)Dicrotic notch(caused by closure of pulmonary valve) is on the right of the wave form and (RVP)anacrotic notch (indicates atrial kick) is on the left side of the wave form.

Question 23

PCWP

Answer 23

Measured with balloon inflated.
Red port- 1.5mL of air
Indirectly reflects LAP, preload of the left side
Normal is 8-12mmHg

Question 24

Abnormal PCWP causes

Answer 24

> decreased: hypovolemia or vasodilator meds
increased: LV failure, mitral valve disease, cardiac tamponade or fluid overload

Question 25

Triangle method

Answer 25

*Resuscitating a shock patient
Volume—>HR—>SVR
Too much or too little fluid?
Too fast or too slow HR?
Low SVR? Vasodilated? High SVR?

Question 26

When will CVP and PCWP not mirror eachother

Answer 26

In RIght Heart Failure