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CCRN > Hemodynamics > Flashcards

Hemodynamics Flashcards

1
Q

How do you calculate the cardiac output? And what is the normal range?

A 
CO = SV x HR
Normal = 4-8 L/min
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2
Q

What is the normal cardiac index?

A

2.5-4L/min/m2

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3
Q

What is stroke volume (SV) and what happens to CO if SV increases?

A

Stroke volume is how many mL per beat the left ventricle ejects. It is determined by the preload, afterload, and contractility.

If SV increases the CO increases

normal SV = 50-100ml/beat

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4
Q

How do you measure afterload? What happens to the SV and CO as the afterload increases?

A

It is measured by the PVR (right ventricle) and SVR (left ventricle)

as afterload increases the SV and CO decrease

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5
Q

What is a normal CVP (aka RAP)?

A

2-6mmHg

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6
Q

what is a normal pulmonary artery pressure?

A

30-20/ 15-8

mean <20mmHg

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7
Q

What is a normal PAOP?

A

8-12 mmHg

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8
Q

what is a normal SVR?

A

800-1200 dynes/s/cm-5

(MAP -CVP) / CO x 80

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9
Q

What is the normal for PVR?

A

50-250 dynes/s/cm-5

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10
Q

what is the normal range for mixed venous oxygen saturation (SvO2)?

A

60-75%

Direct measurement in pulmonary artery

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11
Q

what is the normal for a central venous oxygen saturation (ScvO2)?

A

> 70%

direct measurement in the superior vena cava

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12
Q

what is the normal arterial oxygen saturation (SaO2)

A

95-99% on RA

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13
Q

Dopamine at high doses will have an effect on what?

A

heart rate

Dopamine at high doses (11-20mcg) will increase BP, PAP, PAOP, CO, SV, SVR and PVR

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14
Q

Levophed increases in all aspects of hemodynamics, but what does it have the greatest effect on?

A

SVR

no changes to HR

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15
Q

Phenylephrine has a hemodynamic effect on which elements?

A

BP, SV/SI, SVR

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16
Q

Epinephrine increases all aspects of hemodynamics but has the greatest effect on what?

A

SVR

increases the HR too

17
Q

Which medications increase your preload?

A 
volume expanders (crystalloid, collids) 
pressors
18
Q

Which medications decrease your preload?

A

Diuretics
Dilators (nitrates, nitroprusside, nesiritide)
Morphine (vasodilates venous bed)

19
Q

Which medications increase your afterload?

A

Vasopressors

levo, neo, epi, and at high doses dopamine

20
Q

Which medications decrease your afterload?

A 
ACE inhibitors
Calcium channel blockers
IABP
Nitroprusside
Nitroglycerin at high doses
21
Q

which medication increase contractility?

A

Positive inotropes

Dobutamine, Dopamine (5-10mcg/kg/min), Primacor, Epinephrine

22
Q

Which medications decrease your contractility?

A 
negative Inotropes 
(Beta blockers, calcium channel blockers) 
Metabolic problems ( metabolic acidosis, endotoxins of sepsis)
23
Q

When would you see a “giant V wave” on a PAOP waveform?

A

During mitral valve insufficiency. This is associated with acute inferior wall myocardial infarction/papillary muscle disfunction/rupture

24
Q

What happens if you arterial waveform is overdamped?

A

results in falsely DECREASED SBP and falsely HIGH DBP as well as a diminished or absent dicrotich notch

this may be due to air or blood in the clot system, loose connections, loss of air in the pressure bad, kinking of the catheter/tubing system

25
Q

What happens if your arterial waveform is underdamped?

A

results in falsely HIGH SBP and a possible falsely low DBP and “ringing” artifact on the waveform

This may be due to pinpoint air bubbles in the system, add-on tubing, or defective transducer

26
Q

In cardiogenic shock, all compensatory mechanisms to maintain CO have failed, what hemodynamic profiles do you expect to be elevated in this type of shock?

A

PAOP and SVR

Elevated left ventricular preload (PAOP) with associated pulmonary symptoms
Elevated left ventricular afterload (SVR) due to vasoconstrictive compensatory mechanisms

27
Q

A patient is admitted with the following clinical findings: Chief complaint of SOB and fatigue, bibasilar crackles noted with S3 gallop, CT chest illustrated venous congestion and cardiomegaly, weight increase of 20lbs over the last two weeks.
Which of the following hemodynamics is found with this patient and what tx is indicated?
A. increase afterload, decrease contractility, and decrease preload;nesiritide to increase contractility
B. decrease afterload, decrease contractility, and increase in preload; lasix to increase afterload
C. decrease afterload, increased contractility, and increase preload; amiodarone to decrease preload
D. increase afterload, decrease contractility, and increased preload; dobutamine to increase contractility

A

D
The patient reflects heart failure. To compensate for the reduced cardiac output, a patient in heart failure vasconstricts. Therefore, afterload is high. Due to the low EF, the left heart pressures increase resulting in lung crackles, s3 heart sounds, and increase preload

CCRN (8 decks)

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