IABP 2

Question 0

When is Systole on an EKG?

Answer 0

From the beginning of the QRS through the 1st half of the T Wave

Question 1

Where is diastole on an EKG?

Answer 1

2nd half of the T Wave to the beginning of the QRS complex

Question 2

When is diastole on the arterial line?

Answer 2

From the beginning of the diacritic arch to beginning of the anacrotic limb

Question 3

When is systole on the arterial line?

Answer 3

From the beginning of the anacrotic limb to the beginning of the beginning of the diacritic notch

Question 4

When is it better to time IABP with an arterial lines?

Answer 4

It patient is tachycardia or in in atrial fibrillation, (hard to time it with an EKG with no p waves or fast rate)

Question 5

When is it better to time the IABP with an EKG?

Answer 5

If patient is hypo or hypertensive

Question 6

What does A stand for on Balloon Pumping?

Answer 6

one complete cardiac cycle

Question 7

What does B stand for?

Answer 7

unassisted aortic end diastolic pressure

Question 8

What is the term for your aortic blood pressure without blowing up the balloon at the end of diastole?

Answer 8

B - unassisted aortic end diastolic pressure

Question 9

What does C stand for?

Answer 9

unassisted systole - balloon pump has not effected it

Question 10

What does D stand for?

Answer 10

diastolic augmentation

Question 11

What does D reflect?

Answer 11

the increased pressure in the aortic root when the balloon is inflated

Question 12

What is the term for when you inflate the balloon in the aortic arch, therefore increased the coronary artery perfusion?

Answer 12

“D” - diastole augmentation

Question 13

What do you need to be careful with not confusing D - diastolic augmentation with?

Answer 13

diastolic blood pressure

Question 14

What does E stand for?

Answer 14

Reduced Aortic end diastolic pressure

Question 15

What does F stand for?

Answer 15

Reduced Systolic pressure - the Next systole after deflation

Question 16

When inflation occur at the beginning of diastole, what does it show on the arterial line?

Answer 16

it gives rise to a sharp “V” on arterial waveform

Question 17

What does inflation of the balloon cause?

Answer 17

increased coronary perfusion

Question 18

When does deflation occur?

Answer 18

at the end of diastole prior to systole

Question 19

What does deflation result in?

Answer 19

reduction of aortic end-diastolic and systolic pressures

Question 20

What are the effects of deflation?

Answer 20

1. decreased afterload
2. decreased cardiac work
3. decreased myocardial O2 consumption
4. increased CO

Question 21

What can R-Wave deflation provide?

Answer 21

more effective support for patents experiencing arrhythmias

Question 22

What effect does “F” have on the body?

Answer 22

pressure is lower and heart uses less O2 due to effects of aortic balloon pump

Question 23

When we are looking at balloon pumping, what are we looking at?

Answer 23

the diastole, and then the systole following the balloon pumping

Question 24

What do mmHg difference do we expect to see between C and D?

Answer 24

10-15mmHg difference

Question 25

What mmHg difference do we expect to see between B and E?

Answer 25

10-15mmHg difference

Question 26

What mmHg difference do we expect to see between C and F?

Answer 26

10-15 mmHg difference

Question 27

What difference do we expect in the systolic and diastolic pressures and the coronary perfusion?

Answer 27

systolic lower diastolic lower coronary perfusion higher

Question 28

What is premature Augmentation?

Answer 28

inflation of the ballon prior to the dicrotic notch (early inflation)

Question 29

What can happen in Premature Augmentation to the aortic valve?

Answer 29

premature closure or aortic regurgitation

Question 30

What can happen to the LV end-diastole in Premature Augmentation?

Answer 30

increase in LV end diastolic volume and pressure (or wedge pressure)

Question 31

What can happen to the the LV in Premature Augmentation?

Answer 31

increased wall stress or afterload

Question 32

What can happen to the myocardial O2 demand in Premature Augmentation?

Answer 32

increases demand

Question 33

When the balloon inflated too early and the aortic valve isn't closed yet, what can happen to the LV?

Answer 33

blood is regurgitated back into LV and you could volume overload the LV

Question 34

What are the 5 potential physiological effects of Premature Augmentation?

Answer 34

1. premature closure of the aortic valve 2. increase in LV-EDV and LV-ED'P' (or wedge pressure) 3. increased LV wall stress (or afterload) 4. aortic regurgitation 5. increased myocardial O2 demand

Question 35

What is the term for Inflation of the balloon way after closure of aortic valve?

Answer 35

Late Augmentation

Question 36

What will the physiologic effect be in Late Augmentation?

Answer 36

sub-optimal coronary artery pressure

Question 37

Why is their sub-optimal coronary artery pressure with Late Augmentation?

Answer 37

most of the blood has already passed the coronary arteries but the time the inflation occurs

Question 38

Will late augmentation hurt the patient?

Answer 38

no, it just won't help them

Question 39

What is premature deflation of the balloon during diastolic phase?

Answer 39

early deflation

Question 40

What are the Physiologic effect of Early Deflation?

Answer 40

1. sub-optimal coronary perfusion 2. potential for retrograde coronary and carotid blood flow (coronary steal) 3. sub-optimal afterload reduction 4. increased myocardial O2 demand

Question 41

What is coronary steal?

Answer 41

a type of suction in the aortic root that causes the blood that was about to flow to the coronaries to come back out because of pressure changes

Question 42

How does Early Deflation cause coronary steal?

Answer 42

you increase the pressure in the aorta with inflation and with early deflation you suddenly decreased the pressure in the aorta

Question 44

Can you harm coronary perfusion with Early Deflation?

Answer 44

yes

Question 45

What are the physiologic effects of Late Deflation?

Answer 45

impede LV ejection | increased afterload

Question 46

Why is there an increased myocardial consumption with Late Deflation?

Answer 46

due to LV ejecting against a greater resistant and prolonged isovolumetric contraction phase

Question 47

What is the absolute worst thing you can do with balloon pumping?

Answer 47

Late Deflation

Question 48

Why is Late Deflation the absolute worst thing you can do with balloon pumping?

Answer 48

because you are blocking the blood from leaving the ventricle on the next beat, thereby INCREASING myocardial O2 consumption, marking heart work harder

Question 49

What is the least harmful but not helpful inflation?

Answer 49

Late Inflation

Question 50

What is the next to worst inflation timing?

Answer 50

Early Inflation, not as bad as Late Inflation but still harmful

Question 51

What do you want to see a 5-15 mmHg difference between with Balloon Pumping?

Answer 51

1. the assisted (reduced) aortic end diastolic pressure to be lower than the unassisted aortic end diastolic pressure 2. Assisted (reduced) systolic pressure to be lower than unassisted systolic pressure

Question 52

How can the balloon pacing timed?

Answer 52

1:1 1:2 or 1:3

Question 53

If the balloon pacing is 1:1, can we tell how the patient is doing?

Answer 53

not really

Question 54

What do you have to switch the pacing to to see if they are doing better?

Answer 54

1:2 (at least long enough to get numbers)

Question 55

How do you know from the pulse pressure if the patient is getting getter with balloon pump?

Answer 55

if the pulse pressure widens

Question 56

Should the MAP change much?

Answer 56

no

Question 57

How should the Wedge pressure change?

Answer 57

levels should get better since it's an indication of stress of the LV

Question 58

How should the systemic vascular resistance change?

Answer 58

should decrease --> decreased afterload

Question 59

How should CO change?

Answer 59

increased CO and may need less medication to get it

Question 60

How will renal function be effected with balloon pump?

Answer 60

should improve due to increased CO

Question 61

What are some other things that will be a result of balloon pumping?

Answer 61

``` less edema less angina improved LOC less arrhythmias better oxygenation improved ABG labs ```

Question 62

If patient has no potential for recovery, should balloon pumps be used?

Answer 62

no

Question 63

If patient has end-stage CHF, irreversible brain damage, or really large infarct and not expecting positive outcome, should they get balloon pump?

Answer 63

no, all you'll do is prolong their suffering

Question 64

Do balloon pumps fix or repair anything?

Answer 64

no, it only allows heart to rest and recover

Question 65

Why can't patients who have a dissecting aortic/thoracic aneurysm get a balloon pump?

Answer 65

will make it worse, rupture

Question 66

Are trauma patients usually good candidates for balloon pumps?

Answer 66

no

Question 67

Why will severe PVD patients not usually get a balloon pump?

Answer 67

they cannot physically thread it

Question 68

Will patients get balloon pump with incompetent aortic valve?

Answer 68

if it's mild they may, but anything more than mild with worsen the insufficiency

Question 69

If patient has Blood Dyscrasias, how will the balloon effect the patient?

Answer 69

over time it will destroy platelets and since they already have a bleeding disorder, it will make it worse the longer its in

Question 70

what are the immobility complication with balloon pumps?

Answer 70

can't elevate the HOB | have major tube in femoral artery

Question 71

What are some of the other complications with Balloon Pumps?

Answer 71

1. infection 2. bleeding disorders (femoral hemorrhage if it comes unhooked) 3. Decreased perfusion distal to site