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Critical Care Test 2 > Hemodynamics > Flashcards

Hemodynamics Flashcards

(91 cards)

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1
Q

what does the dicrotic notch signify

A

aortic valve closure

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2
Q

Pulsus Paradoxus

A

Inspiration decreases SBP by >10 mmhg

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3
Q

what does pulsus paradoxus indicate?

A
  • Cardiac Tamponade
  • pericarditis
  • lung disease
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4
Q

Pulsus Alternans

A

Regular pattern of pulses amplitude changes that alternate between stronger and weaker beats

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5
Q

Pulsus alternans- what does it indicate

A

End-stage left ventricular heart failure

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6
Q

Pulmonary Artery Line types

A

Swan Ganz, PA line, Right heart catheter

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7
Q

Components of PA Line

-Proximal Injection Port

A

measures CO and CVP

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8
Q

Components of Swan-Ganz

-PA distal Port

A

measures pulmonary artery pressure

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9
Q

Components of Swan Ganz

-balloon inflation port

A

used to inflate the balloon for the flotation during insertion and obtaining PAWP
-use 1-1.5 cc of air

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10
Q

Components of Swan-Ganz

-Thermistor wire connector

A

measures CO

and blood temperature

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11
Q

Compoents of Swan Ganz

  • CCO
  • SvO2 connector
A

measures continuous CCO

-measures SvO2

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12
Q

Indications for PA catheter

A
  • monitor cardiac function (MI, CHF)
  • monitor fluid status
  • Assess the hemodynamic response to fluids, diuretics, vasoactive agents, inotropes
  • manage hemodynamic instability after heart surgery
  • guide shock tx
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13
Q 
PA catheter monitoring meaning:
1- CO /CI
2-CVP
3-PAOP
4-SVR
A

1- how well the heart pump is pumping
2- how full the right side of the heart is
3- how full the left side of the heart is
4- how well the pts arteries can squeeze

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14
Q

NORMAL VALUES

CVP
PPV

A

2-5

7-10

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15
Q

NORMAL VALUES

PAP

A

20-30/ 5-10

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16
Q

NORMAL VALUES

-PAOP

A

5-12

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17
Q

NORMAL VALUES

-SvO2

A

60-75%

*from a central line: 70-80%

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18
Q

NORMAL VALUES

-CO

A

4-6 L

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19
Q

NORMAL VALUES

-Cl

A

2.2-4.0 L

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20
Q

NORMAL VALUES- calculated

-SVR

A

800-1400

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21
Q

NORMAL VALUES- caclulated

-PVR

A

100-250

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22
Q

NORMAL VALUES- calculated

-SV

A

60-70

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23
Q

NORMAL VALUES- Calculated

-SV Index

A
  • 40-50
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24
Q

Locations:

  • Central line
  • PA line
A
  • right atrium

- Pulmonary artery

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25
CVP definition
central venous pressure: pressure of blood in the thoracic vena cava, near the right atrium of the heart - reflects the amt of blood returning to the heart * *RIGHT VENTRICULAR PRELOAD
26
PAP definition
Pulmonary Artery Pressure
27
PAWP definition
Pulmonary Artery Wedge Pressure | -LEFT VENTRICULAR PRELOAD
28
CO definition
volume of blood pumped out by heart in one minute
29
CI definition
cardiac index- cardiac output adjusted for body size
30
SV definition
Stroke volume- volume ejected with each heartbeat
31
SVI- stroke volume index definition
stroke volume adjusted for body size
32
SVR definition
systemic vascular resistance- measures left ventricular resistance (AFTERLOAD) an index of arteriolar compliance or constriction throughout the body
33
PVR definition
Pulmonary vascular resistance- measures left ventricular resistance (AFTERLOAD)
34
Afterload definitin
resistance against which ventricle pumps
35
Why measure ScVO2
Vital signs may be late indicators of compromised oxygen levels, - the goal of continuous ScVO2 is t show the relationship between oxygen demand and oxygen consumption * * GIVES PICTURE OF GLOBAL TISSUE PERFUSION
36
1- ways that oxygen is delivered | 2- ways that oxygen is consumed
1- cardiac output, hgb, oxygenation | 2-metabolic demand
37
Reasons metabolic demand/oxygen consumption would be high
``` Fever anxiety pain shivering muscle activity ``` *TREAT WHAT IS CAUSING CONSUMPTION
38
what organ typically fails first when oxygenation is low?
the kidneys | -*this is because blood is shunted to vital organs such as the brain and heart
39
how to calculate: | CO
CO= SV x HR
40
How to calculate | SVR
(BP-CVP)/CO x 80
41
how to calculate: | MAP
2(DBP) + SBP / 3
42
How to calculate: CI
CO/BSA
43
How to calculate: | BSA
sqr rt: weight (kg) x height(cm)/ 3600
44
how to calculate: | SVI
SV/BSA
45
Primary Assessment of Central Lines
- is pt stable? - check catheter position - is each port being used properly? - check connections - check tubes for kinks/bubbles - is balloon deflated - Level and zero the transducer - approp. scale for PA catheter - contonuous flush is maintained at 300 mmhg
46
Pulmonary artery wedge pressure waveform
small waves | * dont leave line in there for >15 seconds!!
47
where do you zero the trasnducer?
the phlebostatic axis | -4th intercostal space, level of atria
48
Pt positioning for zeroing a line
- HOB 0-60 degress - no lateral positioning - phlebostatic axis
49
Square Wave Testing
tests the systems accuracy reflecting the pressure and the waveform from the patients ** COUNT OSCILLATIONS after the square wave. each oscillation should be no more than 1/3 height the previous oscillation
50
Abnormal waveforms 1- overdamped causes
- air, blood clots in the tubing - tubing is too long or kinked - connections are loose *interventions: unkink, loosen, remove clots ect
51
Abnormal waveform: 2- Underdamped -causes
-Air bubble | Interventions* remove bubbles or get new transducer
52
Abnormal waveforms: | -deflated balloons become wedged!
notify MD immediatly! urgent intervention
53
PA Ports Uses | - Proximal injection port
NO TITRATED MEDS! this boluses a med into the heart and takes too long can infuse 482 ml/hr infusions
54
PA port uses | -PA distal port
NO MEDS!! | used for mixed venous blood
55
PA Port Uses | -RA port
HIGH VOLUME INFUSIONS
56
PA Port uses | -RV port
LOW VOLUME INFUSIONS | nothing over 50 cc/hr
57
how long can you wedge for in PA line
no more than 15 sec
58
can you leave wedge in permanent wedge position?
NO
59
Active or passive deflation of balloon?
PASSIVE
60
what can be used in place of wedging ?
Pulmonary artery distal pressure
61
how much to inflate wedge balloon
no more than 1.5 cc
62
what do you use to inflate the balloon
1.5 ml syringe that cones with the balloon
63
Arterial Lines | -functions
- continuous BP readings - Serial ABGs - less invasive hemodynamic monitoring
64
how to do CO readings
- put pt supine or HOB 30 CO would be lower d/t postural effect of venous return - verify computation constant - take average of 3 measurements - set up tubing for 500 cc D5W bag - inject 10 cc smoothly in
65
Swan Complications
- air embolus | - disconnected tubing
66
swan complication | -pulmonary infarction
PA rupture of ballon, prolonged inflation of balloon, spontaneous wedging
67
PA complication | -ventricular irritation
when catheter migrates back to the RV or is looped thru the ventricle * CALL MD * can cause Ventricular Tachycardia!
68
PA complication | -risk of Infection
an occlusive dressing or biopatch
69
PA complications: | -Thrombosis and embolus
air embolus may occur when the balloon ruptures, | clot on end of catheter can cause pumlonary embolus
70
PA complications: | -catheter wedges permanently
-EMERGENCY FLAT LINE PA waveform can cause pulmonary infarction in only minutes
71
Treating PRELOAD
treat until CVP & PAWP normal ranges | -(VOLUME) filling volume of ventricles
72
Treating AFTERLOAD
Treat until SVR & PVR normal values | -(SQUEEZE) pressure that ventricles overcome to get blood out of the heart (SVR)
73
Treating Contractility
Treat until CO & SV normal values -(PUMP) strength of myocardial contraction during systole. Frank-starling law: the greater the stretch , the greater the contraction. (SV/CO)
74
- left ventricular preload | - right ventricular preload
- PAWP | - CVP
75
INCREASED PRELOAD (CVP/PAWP) causes
- adult respiratory distress syndrome - Heart failure - Pulmonary edema
76
treatment for increased PRELOAD
- Diuretics - Mannitol - Furosemide - Bumetanide
77
``` DECREASED PRELOAD (CVP, PAWP) causes ```
- hypovolemia | - Septic shock
78
Treatments for Dec. PRELOAD (CVP, PAWP)
Volume booster - Colloids - Crystalloids - blood - hetastarch
79
INCREASED PVR (pulmonary vascular resist) causes
-PVR = (MPAP-PAWP) x 80/CO pulmonary HTN -hypoxia -pulmonary emboli
80
Treatment Increased PVR | -INOTROPES
Inotropes (DIGOXIN)- incr. hearts pumping ability | -
81
Tx Increased PVR | -vasodilators
Vasodilators (Procardia)- lowers pulmonary blood pressure and incr. heart ability to pump from the right side
82
Tx Increased PVR | -Epoprostenol
FLOLAN- dilates pulmonary artery
83
Tx INCR PVR | -Diuretics
LASIX/ALDACTONE- removes extra fluid from the tissues and bloodstream, reduces swelling and makes breathing easier
84
``` Increased contractility (SV / CO) causes ```
Any shocks | -increased sympathetic activity
85
``` Increased contractility (SV/CO) -tx ```
Beta blocker, CCB
86
``` Decreased CO (SV/CO) -causes ```
``` hypothermia hypoxemia low coronary perfusion MI cardiomyopathy ```
87
Decr. Contractility | -tx
- Positive Inotropes - (Doputamine - Dopamine)
88
Positive Inotropic Agents
Increase myocardial contractility | DOPAMINE/DOBUTAMINE
89
Negative Inotropic Agents
Decrease myocardial contractility BB CCB (CARDIZEM, VERAPMIL)
90
Positive Chronotropes
Increase heart rate | ATROPINE, DOPAMINE, EPI
91
Negative Chronotropes
-decrease HR -BB (metropropol) -Digoxin Cardizem

Critical Care Test 2 (6 decks)

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