🩸Hemodynamics

Question 1

Cardiac Output

Answer 1

SV x HR

indicator of inotropic ability
4-8L/MIN

Question 2

Cardiac Index

Answer 2

CO/Body Surface Area
2.2-4.0L/min

Question 3

3 Factors of Stroke Volume

Answer 3

1. Preload
2. Afterload
3. Contractility

Question 4

Preload

Answer 4

volume indicator
stretch before systole “filling pressure”

Question 5

Elevated Preload causes (5)

Answer 5

Volume overload
Left/Right Ventricular Dysfunction
Valvular stenosis or insufficiency
Cardiac Tamponade

Question 6

Increased right ventricular vs left ventricular

Answer 6

Right = BODY –> hepato-juglar reflux, JVD, edema (increased systemic pressure)
Left = LUNG –> crackles, S3, cough (increased wedge pressure)

Question 7

Preload reduction –> direct reduction of blood volume

Answer 7

Diuretics

Question 8

Preload reduction –> promote vasodilation

Answer 8

Nitrates (Nitroglycerin)

Question 9

Preload reduction –> patient positioning

Answer 9

Semi-fowlers
High - fowlers

Question 10

Preload reduction is caused by (5):

Answer 10

Hypovolemia
Hemorrhage
Third Spacing
Diuresis
Vasodilation

Question 11

Preload reduction assessment findings:

Answer 11

Tachycardia/hypotension
dry, cool skin
dry mucous
poor skin turgor
alt LOC
decreased UOP/vital organ perfusion

Question 12

Tests for preload

Answer 12

CVP R
PCWP L

Question 13

Treatment for low preload (Non-pharm)

Answer 13

Volume administration (Crystalloid, colloid, PRBC)
Modified trendelenburg

Question 14

Afterload

Answer 14

resistance to stretch, FORCE

Question 15

Afterload critical factor

Answer 15

systemic vascular resistence

Question 16

afterload elevation is caused by (5):

Answer 16

vasoconstriction (increased SVR)
alpha 1 agonist –> epi, norepi
catecholamine release
Hypertension
increased aortic impedance (stenosis)

Question 17

Afterload reduction –> arterial dilation

Answer 17

nitroprusside (nipride)

Question 18

Afterload reduction –> block angio 1 - 2

Answer 18

ACE-I/ARBS
(-pril) (-sartan)

Question 19

Afterload reduction is caused by (4):

Answer 19

vasodilation (decreased SVR)
inadequate aortic valve function
inflammatory response
hyperthermia

Question 20

Pharm to increase afterload

Answer 20

Vasopressors
Norepi (levophed)
Phenlyephrine
Dopamine
Vasopressin

Question 21

Contractility

Answer 21

inotropic action THE PUMP
+ increase
- decrease

Question 22

Pathophys factors influencing contractility (5):

Answer 22

calcium and ATP
coronary artery perfusion
o2 supply/demand
heart rate (brady decreases stroke volume; tachy decreases stretch)
BP
valvue competence

Question 23

Low contractility assessment

Answer 23

Tachycardia
Cool, pale skin
DUOP
Mental status changes
Poor peripheral circulation

Question 24

Contractility critical values

Answer 24

CO/CI, ejection fraction via echo 50-70% norm

Question 25

Positive Inotropic agents

Answer 25

increase volume dobutamine, dopamine, digoxin, milrinone

Question 26

Negative Inotropic agents

Answer 26

decrease contractility beta blockers and calcium channel blockers

Question 27

Inotropic

Answer 27

myocardial contraction

Question 28

Chronotropic

Answer 28

heart rate

Question 29

Dromotropic

Answer 29

rate of electrical conduction in AV node digoxin, CCB decrease AV node conduction decrease HR

Question 30

Sympathetic

Answer 30

adrenergic response beta receptors

Question 31

Beta 1 receptors

Answer 31

in the heart stim produces + chronotropic/iontropic

Question 32

Beta 2 receptors

Answer 32

located in bronchial and vascular smooth muscle bronchodilation

Question 33

Alpha 1 receptors

Answer 33

AFTERLOAD effected here! vascular smooth muscle produces vasoconstriction (INCREASED SVR)

Question 34

Parasympathetic

Answer 34

cholinergic response acetylcholine negative dromotropic and chronotropic effects

Question 35

Vagus nerve

Answer 35

innervared PNS with the heart

Question 36

PA cath monitors all hemodynamic parameters aside from:

Answer 36

systemic blood pressure

Question 37

Leveling/Zeroing

Answer 37

1) Level stopcock of transducer to phlebostatic level 2) Each HOB change 3) Zero balance transducer ## Footnote https://www.youtube.com/watch?v=vN2_oG9xW50

Question 38

Phlebostatic Axis

Answer 38

reference level for placement --> for accuracy 1st line --> first ICS at sternum 2nd line --> mid between anterior/posterior chest (mix axillary)

Question 39

Systolic Art Pressure

Answer 39

ejection left ventricular systole (highest wave)

Question 40

Diastolic Art Pressure

Answer 40

end-diastole prior to systolic upstroke

Question 41

Mean Arterial Pressure

Answer 41

perfusion pressure >60 to adequately perfuse vital organs 70-90 IDEAL

Question 42

Pre-procedure (Art line)

Answer 42

Allen's test

Question 43

Central Venous Pressure

Answer 43

measures pressure (VOLUME) in right atrium/vena cava R ventricular preload

Question 44

Normal CVP

Answer 44

less than 8

Question 45

Which CVP port is closest to right atrium?

Answer 45

Distal, used for CVP

Question 46

CVP complications (5)

Answer 46

CLABSI Dislodgment Pneumothorax Thrombosis Air embolism (at removal)

Question 47

PA (Swan) Catheter

Answer 47

diagnose/evaluate heart disease/shock states

Question 48

PA Distal Lumen

Answer 48

open to PA obtain pressures here

Question 49

PA Proximal lumen

Answer 49

open to vena cava/right atrium deliver bolus here

Question 50

Parameters measured with PA cath?

Answer 50

Everything hemodynamic SVR, CO, CVP

Question 51

Cardiac Output - thermodilution method

Answer 51

10ml room temp saline

Question 52

CO required clinical practice skills (4)

Answer 52

supine 0-60 degrees zero level get measurements

Question 53

Complications PA monitoring

Answer 53

Ventricular dysrhythmia PA rupture or perforation

Question 54

If there is a clot in PA cath what do you do?

Answer 54

aspirate before flushing