Hemodynamics

Question 1

What is an A-line used for? What will you see on the wave form?

Answer 1

Continuous BP monitoring & ABG’s.

You will see a dicrotic notch.

Question 2

What is pulses paradoxus?

Answer 2

Diminished amplitude on inspiration in SBP greater than 10. Suggestive of cardiac tamponade, pericarditis or lung disease.

Question 3

What is Pulsus Alternans?

Answer 3

Regular pattern of pulse amplitude changes that alternate between stronger and weaker beats. Suggestive of end-stage left ventricular heart failure.

Question 4

What is a PA Catheter (Swan Gangze) used for?

Answer 4

C.O, CI, & fluid balance
CVP measures right side of heart
PAOP/PAWP measures left side of heart
SVR measures how well your arteries can squeeze

Question 5

What are complications of PA catheters?

Answer 5

• Air embolus, infection, thrombosis
• PA rupture causing pulmonary infarction
• Ventricular irritation when cath migrates back into RV or loops. Can cause VT.
• Catheter wedges permanently, shows flat PA waveform. Risk of infarct after 3 min.

Question 6

NORMAL VALUES

• CVP
• PAP
• PAOP

Answer 6

• CVP 2-5mm Hg
• PAP 20-30/5-10
• PAOP 5-12

Question 7

NORMAL VALUES

• SVO2 (where do we measure it from?)
• SCVO2 (where do we measure it from?)
• CI

Answer 7

• SVO2 60-75% (from A-line)
• SCVO2 70-80% (from central line)
• CI 2.2-4.0L

Question 8

NORMAL VALUES

• SVR
• PVR
• SV
• SV index

Answer 8

• SVR 800-1400
• PVR 100-250
• SV 60 - 70mL
• SV index 40-50

Question 9

What measures pre-load?

Answer 9

CVP & PAOP

Question 10

What measures after load?

Answer 10

SVR

Question 11

What measures contractility?

Answer 11

C.O & SV

Question 12

What is cardiac index?

Answer 12

Cardiac output adjusted for body size

Question 13

What is SVI?

Answer 13

Stroke volume adjusted for body size

Question 14

What is after load?

Answer 14

resistance against which ventricle pumps

Question 15

What does SVR measure?

Answer 15

systemic vascular resistance measures left ventricular after load.

Question 16

What does PVR measure?

Answer 16

Pulmonary vascular resistance against which the right ventricle works.

Question 17

How to calculate CI?

Answer 17

CO/BSA

Question 18

What is the proximal injectate port on the PA catheter used for?

Answer 18

Infusions up to 492 ml/hr. DO NOT put titrated meds in this port.

Question 19

What is the PA distal port used for?

Answer 19

Measuring mixed venous blood. DO NOT infuse meds.

Question 20

What is the RA port used for in the PA catheter?

Answer 20

HIGH VOLUME infusion.

Question 21

What is the RV port used for in the PA catheter?

Answer 21

LOW VOLUME infusions less than 50ml/hr

Question 22

How long do you wedge for?

Answer 22

No longer than 15 seconds

Question 23

How do you deflate the PA wedge?

Answer 23

Passive deflation.

Question 24

How many ml of air do you inflate the wedge balloon with?

Answer 24

No more than 1.5ml. Only use 1.5ml syringe supplied with catheter.

Question 25

What is square wave testing?

Answer 25

Reflects the accuracy of the pressure and waveform. Should use fast flush and observe a square wave.

Question 26

What happens to CO and SVR during cardiogenic shock?

Answer 26

CO goes down. | SVR goes up.

Question 27

What happens to CO, central pressures and SVR during hypovolemic shock?

Answer 27

CO goes down. Central pressures go down SVR goes up.

Question 28

What happens to CO, central pressures and SVR during septic shock?

Answer 28

CO goes UP. Central pressures go down. SVR goes down.

Question 29

In what order do we tx hemodynamic instability?

Answer 29

1. Preload (CVP & PAWP) 2. Afterload (SVR, PVR) 3. Contractility (CO, SV)

Question 30

Your patient is in heart failure and his CVP is 8. What are some possible medications you can administer to decrease preload?

Answer 30

Nitro Nipride Furosemide Mantiol

Question 31

Your patient is in hypovolemic shock. What can you administer to increase preload?

Answer 31

Administer Colloids, crystalloids, blood, hetastarch, antiarrhythmics.

Question 32

Your patient is in hypovolemic shock. What can you administer to decrease after load (SVR)?

Answer 32

Nitro Alpha Adrenergic Blockers CCB

Question 33

Your patient is in early septic shock. What can you administer to increase after load (SVR)?

Answer 33

Epi, norepi | Dopamine

Question 34

Your patient is hypoxic and a PVR of 350 (100-250). What are possible medications for this patient?

Answer 34

- Inotropic agents (Digoxin) to increase force of contraction. - Vasodilators (Procardia, Cardizem). Lowers pulmonary BP and improves pumping ability of R side of heart. - Epoprostenol (Flolan). Dilates pulmonary arteries. - Diuretics (lasix, aldactone). Removes fluid/reduces swelling, improves ventilation.