*Hemodynamics Flashcards
(150 cards)
1
Q
a-line waveform feature that represents aortic valve closure
A
dicrotic notch
2
Q
how to determine proper pressure in a-line system
A
determine dampening
*no more/less than 3 ossillations before returning to baseline
3
Q
too little dampening
A
many ossillations. too little dampening that the ossillations won’t die and continue to reverberate
4
Q
obstruction in a-line system
A
overdampened
5
Q
kinded a-line
A
overdampened
6
Q
air in a-line
A
overdampened
7
Q
pressure bag overfilled
A
overdampened
8
Q
Boyle’s law on a-line
A
overdampened
9
Q
causes of overdampened a-line
A
obstruction in aline system
kinked aline
air in system
pressure bag overfilled
Boyle’s law
10
Q
underdampening
A
a-line system is too dynamic & has too little pressure
11
Q
a-line if pressure bag isn’t full
A
underdampened -too little pressure
12
Q
a-line if noncompliant tubing
A
underdampened - too little pressure
13
Q
what does Swan Ganz measure
A
aka PUlmonary Artery Catheter
*right heart preload/afterload
*left heart preload
14
Q
insertion site of a Swan Ganz/Pulmonary Artery catheter
A
central line into subclavin vein
15
Q
what part of the PA catheter is used to measure pressure
A
distal tip
16
Q
distal tip of the PA catheter
A
measure pressure
17
Q
how much ml air to measure pressure via PA catheter
A
do not exceed 1.5ml
18
Q
how to take wedge pressures
A
PA catheter
no more than 1.5ml into distal port
dtake at the end of exhalation
don’t take for longer than 15 sec or 3 breaths
19
Q
how long to take a wedge pressure
A
no longer than 15 sec or 3 breaths
20
Q
when do you take a wedge pressure
A
at the end of exhalation
21
Q
PA catheter PA port
A
for monitoring/lab samples only
22
Q
PA catheter port for monitoring/lab samples of blood
A
PA port
23
Q
PA catheter port for infusions/fluids
A
proximal ports
24
Q
proximal port on PA catheter
A
influsions/fluids
25
how to transport a pt with a PA catheter
deflate the balloon to prevent an inadgertent wedge pressure when it advances
*balloon size increases at altitude b/c Boyle's Law
26
progression of Swan-Ganz
subclavian
R atrium/ventricle
destination = pulmonary artery
inflate in pulmonary artery to get wedge pressure
27
site where you get the wedge pressure =
pulmonary arteryq
28
dicrotic notch on the left side of PA catheter waveform
RV waveform = tricuspid valve closing
29
dicrotic notch on the right side of the waveform
PA waveform = pulmonic valve closing
30
Central venous pressure
CVP = 2-6mm hg
right heart preload
31
2-6mm hg
Central Venous PRessure
right heart preload
32
Right ventriclar pressure
systolic = 15 - 25mm hg
diastolic = 0-5 mm hg
33
Pulmonary arty pressure
systolic = 15 - 25 mm hg
diastolic = 8-15
34
systolic pressure of right ventricle
15 - 25
35
diastolic pressure of right ventricle
0 - 5
36
systolic pressure of pulmonary artery
15 - 25 mm hg
37
diastolic pressure of pulmonary artery
8-15 mm hg
38
8-15 mm hg
diastolic pressure of pulmonary artery
39
15 - 25 mm hg
systolic pressure of right ventricle & pulmonary artery
40
PAWP
8-12 mm hg
41
8-12 mm hg
PAWP
42
what does PAWP measure
right heart afterload
left heart preload
43
how to measure left heart preload
PAWP
44
how to measure right heart afterload
PAWP
45
calculate coronary perfusion prssure
DBP - PAWP
= 50 - 60
46
normal cardiac index
2.5 - 5 L/min
47
catheter whip
exaggerated waveforms w/elevated systolic pressure and additional peaks (generally only 2 are found) = result of excessive movemnet of the catheter within the artery
48
how to deal w/catheter whip
inflate cuff w/1.5 ml air
cough
lay on right side
49
troubleshooting PA/Swan Ganz catheter
catheter whip
inadvertent wedge
50
2 cause of inadvertent wewdge
balloon migration
ensure the balloon is deflated (Boyle's law)
51
treatment for inadvertent wedge
you'll see a PAWP waveform
* deflate the balloon
* cough
* position pt
*withdraw until you see a PA waveform
52
causes of ireased PA pressure
left ventricular failure
liver failure/portal HTN
cor pulmonary/increased pulmomnary vascular resistance
mitral regurg/stenosis
53
why is MAP decreased in hypovolemia
loss of volume
54
central venous pressure in hypovolemia
decreased
55
CO in cardiogenic shock
decreased
56
central venous pressure in cardiovenic shock
decreased
57
PCWP
pulmonary capillary wedge pressure
58
indirect estimate of left atrial pressure
PCWP = pulmonary capillary wedge pressure
59
PCWP in hypovolemic shock
decreased
60
PCWP in cardiogenic shock
increased
61
800 - 1200
normal SVR
62
50 - 250
PVR
63
shock w/low HR
neurogenic
64
skin temp in neurogenic shock
cool/moist above
warm/dry below
65
central venous pressure in late septic shock
decreased
66
PCWP in late septic shock
decreased
67
SVR in late septic shock
increased
68
CO in anaphylaxis
increased
69
CVP in anaphylasis
decreased
70
PCWP in late anaphylaxis
decreased
71
SVR in anaphylaxis
decreased
72
PAWP where you may need an IABP
PAWP over 18
73
2 effects of IABP
increase coronary perfusion
decrease workload of the heart
74
IABP balloon during systole
deflated
75
IABP balloon during diastole
inflated
76
insertion of IABP
inserted into femoral artery directed towards the heart
77
where does the IABP sit
in descending aorta
distal to left subclavian artery
above renal artery
78
intervention for IABP if power failure
manually pump every 3-5 minutes to prevent blood from clotting on the balloon
79
IABP at altitude
dont need to purge air b/c self burge
80
transporting IABP
bring exter helium tanks
81
how to tell if IABP balloon has ruptured
rust/brown flankes in IABP tubing
-flakes are clotted RBC's inside the tubing
82
rust brown flakes in IABP tubing
IABP balloon has ruptured
83
what happens in IABP if you have normal timing
decreased workload
increased coronary perfusion
84
IABP timing error where blood is forced back into the left ventricle
early IABP inflation
85
when does early iABP inflation occur
inflation before the aortic valve closes
so blood is forced back into the LV
86
effect of early inflation
HARMFUL
aortic regurg
decreased CO
increased SVR
87
when is late inflation of IABP
inflation after the aortic valve closes
88
IABP error when inflation occurs after the aortic valve closes
late inflation
89
appearence of IABP
W
90
W shape of IABP waveform
late inflation
91
U shape of IABP waveform
early inflation
92
problem of late inflation
suboptimal augmentation
decreased coronary perfusion
93
4 shapes of IABP timing errors
early inflation = U
late inflation = W
late inflation = cliff shape
late deflation = widened appearence
94
cliff shape of IABP
late inflation
95
shape of late inflation
cliffe
96
shpe of late deflation
widened appearnce
97
widened appearnence of IABP waveform
late deflation
98
problem s of early deflation
decreaed negative pressure
deflation of balloon beore systole
increased afterload
99
when does the IABP balloon delfate in the timing error of early deflation
deflation of balloon before systole
100
worst IABP timing error
late deflation
101
what happens in late deflation of IABP
inflation of the balloon during systole
102
problems of late inflation IABP
inflation of the balloon during systoole
aincreased afterload & workload
harmful/worst tiing erro
103
Impella
continuous flow pump
pulls blood from the left ventricle and propels blood into the aorta
104
pulls blood from the left ventricle and propels blood into the aorta
Impella = continuous flow pump
105
what does ECMO do
Extracorporeal Membrane Oxygenator
forward blood flow
remove CO2/add oxygen
106
use of ECMO
good for ARDS
hypoxemic
refractory m. ventilation
107
benefit of ECMO over m. ventilation
gas exchange w/o risk of lung injury associated w/ventilator in the presence of catastrophic hypoxemic/hypercarbia
108
SynCardia
type of artifical heart. pulsatile device w/ air-driven diaphragm
109
what does failure to capture look like
packing spikes are present but not followed by a QRS
110
pacing spikes are present but not followed by QRS
failure to capture
111
causes of failure to capture
lead dislodged
low output
lead/pacer failure
112
decreased or absent pacemaker function
failure to pace
113
failure to pace
decreased/absent pacemaker function
114
causes of failure to pacePO 9
oversensing
wire fracture
interference
lead displacement
115
undersensing (pacemaker)
pacemaker fails to sense native cardiac activity
116
pacemaker fails to sense native cardiac activity
undersensing (pacemaker)
117
causes of failure to sense/undersensing
poor lead contact
increased stimulation threshold at electrode site
new BBB
118
calculate CI
CO/BSA
119
what affects right heart afterload
pulmonary arteries (PVR)
120
what affects left heart afterload
SVR
121
what measures afterload
PVR = right afterload
SVR = left afterload
122
what does PVR measure
afterload of right heart
123
normal PVR
50 - 250 dynes
124
increased PVR -5
over 250
acidosis
hypercapnia
hypoxia
atelectasis
ARDS
125
decreased PVR
under 50alkalosis
hypocapnia
vasoD rx
126
effect of pH on PVR
incrased PVR = acidosis
decreased PVR = alkalosis
127
effect of CO2 on PVR
increased PVR = high Co2
decreased PVR = low COw
128
PVR in ARDS
increased over 250
129
PVR in atelectasis
increased PVR over250
130
SVR
800 -1200 dynres
131
difference in PVR & SVR
PRV = afterload of right heart. 50 - 250
SVR = afterload of left heart. 800-1200
132
increased SVR
over 1200
hypothermia
hypovolemic shock
decreased CO
133
SVR if hypovolemia/decreased CO
increased SVR over 1200
134
SVR if hypothermia
increased SVR over 1200
135
decreased SVR
over 1200
anaphylaxis
neurogenic shock
spinal shock
septic shock
vasoD rx
136
SVR if vasoD rx
decreased SVR below 800
137
SVR if distributive shock (all)
decreased SVR below 800
138
SVR in ahaphylaxis
decreased under 800
139
dyne
measures afterload of left heart
force required to accelerate a mass of one gram a rate of one cm per second squared
140
S3
bicuspid/tricuspid close
Kentucky
excessive filling of heart
141
excessive filling of the heart
S3 = Kentucky= CHF
142
heart sound in CHF
S3 = kentucky= excessive filling of heart
143
common cause of S3
CHF. excessive filling of theheart
144
S4
blood being forced into a stiff non-compliant ventricle
MI
145
heart sound in MI
S4. blood being forced into a stiff non-compliant ventricle
146
S3 versus S4
S3 = CHF. excessive filling of hte heart
S4 = MI. blood being forced into a stiff non-compliant ventricle
147
heart sound in hypertrophic cardiomyopathy
S4 = blood being forced into a stiff/noncompliant ventricle
148
heart sound heardd in HTN
S4 = blood being forced into a stiff noncompliant ventricle
149
heart sound in pulmonary/aortic stenosis
S4 = blood being forced into a stiff noncompliant ventericle
150
