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Critical Care Paramedic > 1-8: Hemodynamic Monitoring > Flashcards

1-8: Hemodynamic Monitoring Flashcards

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1
Q

What is the most important aspect of hemodynamic monitoring?

A

determination of the CO

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2
Q

What is stroke volume

A

the amount of blood ejected from the ventricles in each heartbeat

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3
Q

What can affect the stroke volume?

A
  • cardiac contractility (ejection fraction)
  • preload
  • afterload
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4
Q

What is preload

A

also known as left ventricular end diastolic pressure (LVEDP) or CVP (RVP)
- the amount of ventricular stretch at the end of diastole

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5
Q

What is afterload

A

also known as systemic vascular resistance (SVR)
- the amount of resistance the heart must overcome to open the aortic valve and push blood into systemic circulation

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6
Q

What is cardiac output

A

the volume of blood ejected by the heart per minute

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7
Q

What is the normal range for cardiac output?

A

4-8 L/min

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8
Q

What is the equation for CO

A

SV x HR

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9
Q

What are some causes of elevated CO?

A
  • stimulation of the sympathetic nervous system (pain, epi)
  • positive inotropic stimulation
  • hyperthyroidism
  • hypervolemia
  • anemia
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10
Q

What are some causes of decreased CO?

A
  • an increased HR that doesn’t allow for adequate preload ( >150)
  • decreased HR
  • decreased myocardial contractility
  • increased afterload
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11
Q

Why does increased afterload decrease CO?

A
  • afterload is SVR
  • the pressure in the ventricle (4-16) must be higher than the pressure in the aorta (80) to get forward flow
  • afterload is anything that makes it harder to get blood OUT of the heart.
  • Increasing afterload (SVR) is having a higher diastolic BP
  • if your ventricle has to work harder to push blood out of the heart, ultimately LESS blood will be let out.
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12
Q

What is cardiac index?

A

CO / BSA

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13
Q

What is the normal range for cardiac index?

A

2.5 - 4 L/m/m2
and these are hard values, if it hits 2.4, as a medic you need to do something

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14
Q

What value will cardiac index fall below in cardiogenic shock?

A

1.8

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15
Q

What is SvO2 and what is the range?

A

The saturation of hemoglobin on the venous side
normal saturation is 65-75%

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16
Q

What do low and high levels of SvO2 mean?

A

low: more oxygen is jumping off at the tissues, which indicates a decreased tissue perfusion issue.

high: less oxygen is jumping off at the tissues, indicates decreased O2 consumption at the tissue level

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17
Q

What affects preload?

A
  • intravascular volume
  • venous tone (size of the pipes)
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18
Q

Right ventricular preload is the same as CVP, so has a range of:

A

2-8 mmHg

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19
Q

Left ventricular pressure is the same as:

A

LVEDP

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20
Q

What is the range for SVR?

A

800-1200

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21
Q

What is the value for pulmonary vascular resistance?

A

<250 dynes/sec/cm5

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22
Q

Can a single measurement be used in isolation to assess hemodynamics?

A

no, silly

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23
Q

What are the parameters of hypotension?

A
  • SBP < 90
  • SBP decrease of >40 under baseline
  • MAP <65
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24
Q

Is it possible for a patient to have a normal BP yet have hypoperfusion and be in shock?

A

yes

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25
Q

What is the formula for shock index?

A

HR / SBP

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26
Q

What is the normal range for shock index?

A

0.5 - 0.7

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27
Q

What is the value of shock index that indicates early circulatory collapse and shock?

A

0.9

28
Q

skin discoloration on what part of the body indicates poor perfusion (for adults vs. kids)

A
  • adults: over knee/leg
  • kids: hands and feet
29
Q

How many lumens does the Swan cath have and what are they?

A

4 lumens
1. proximal ( right atrial)
2. distal ( pulmonary artery)
3. balloon inflation port
4. infusion port

30
Q

Transducers must be calibrated to:

A

ambient air pressure

31
Q

What does the transducer ned to be placed level with? What is another name for it?

A

transducer must be level with the right atrium, also called the phlebostatic axis

32
Q

How does the pressure reading correlate to the position of the transducer?

A

the higher the transducer, the falsely lower the pressure
the lower the transducer, the falsely higher the pressure

33
Q

How should the stopcock be when zeroing the transducer?

A

“off to the patient, open to the air”

34
Q

When should you zero the transducer?

A
  • whenever a reading is taken
  • insertion
  • change in the pts position
35
Q

under what conditions do you leave the swan balloon inflated?

A

none, you silly goose

36
Q

What are some complications that could occur DURING Swan catheter placement?

A
  • dysrhythmia
  • pneumothorax
  • arterial puncture
  • mechanical injury (RV puncture)
  • kinking of the catheter
37
Q

What are some complications that could occur AFTER Swan catheter placement?

A
  • forward catheter displacement (aka spontaneous wedging)
  • backward catheter displacement (tip in RV)
  • pulmonary artery rupture
  • pulmonary artery infarction
38
Q

How can spontaneous wedging be seen and avoided?

A

can be seen: waveform change, lose dichrotic notch
prevented by: taping a reference strip to the monitor for transport

39
Q

What should you do if you suspect forward catheter displacement?

A
  • check to make sure the balloon is deflated
  • check for effect of position change (raise arm above head and cough)
  • turn the pt onto their left side
  • call the physician
40
Q

what is the main concern regarding backward cath displacement of a swan catheter?

A

The catheter needs to be repositioned because catheter whip might cause arrhythmias

41
Q

What are the parts of a CVP waveform and what do they mean?

(be able to draw it out and label it)

A

“a” - produced when the atria contract.
this is the beginning of the cycle
“c” - caused by the closure of the tricuspid valve
“x” and “y” - atrial diastole
“v” - venous filling of right atrium

42
Q

What is the CVP and ranges

A

Central venous pressure

2 - 8

43
Q

What is the RAP and ranges

A

right atrial pressure

2 - 8

44
Q

What do the CVP and RAP reflect?

A

the right ventricular end-diastolic pressure or PRELOAD

45
Q

What causes elevated CVP/RAP?

A

anything that blocks forward flow
- right sided heart failure
- cardiac tamponade
- pulmonary hypertension
- volume overload
- PPV

46
Q

Causes of low CVP/RAP

A
  • volume depletion
  • vasodilation
  • venous vasodilator
47
Q

right ventricular pressure (RVP) normal range

A

0 - 8

48
Q

What causes elevated RVP?

A

** anything that causes higher pressures downstream of the RV**

  • pulmonary disease
  • hypoxemia
  • chronic heart failure
  • RV failure or infarction
  • ventricular septal defect
49
Q

Causes of low RVP

A
  • hypovolemia
  • vasodilation
50
Q

normal values of PAP

A

5 - 15

51
Q

Causes of elevated PAP

A
  • hypervolemia
  • pulmonary hypertension
  • PPV
  • cardiac tamponade
  • left ventricular failure
52
Q

Causes of low PAP

A
  • hypovolemia
  • vasodilation
53
Q

what is the most amount of air used to inflate the swan catheter and when do you stop inflating it?

A

1.5 mL
stop inflating when the waveform changes from PA to PAWP

54
Q

Wedging should last no longer than _____

A

15 seconds

55
Q

What is the range for wedge / PAWP / PCWP / PAOP?

A

4 - 12 mmHg

56
Q

wedge pressure: in spontaneously breathing patients, inspiration is a ____ in pressure and expiration is a ____ in pressure

A

fall, rise

57
Q

Where should the wedge pressure be taken?

A

at end expiration pressure (it is as close as it will get to atmospheric pressure and therefore provides the most accurate reading)

58
Q

Causes of elevated wedge

A

blockage of forward flow
- PPV
- hypervolemia
- left ventricular failure (CHF)
- severe aortic stenosis

59
Q

Causes of low wedge

A
  • hypovolemia
  • vasodilation
60
Q

All ranges:
MAP
CVP
PAS
PAD
PAWP
CO
CI
RVP
PVR
SVR

A

MAP (mean arterial pressure) 70-100
CVP (central venous pressure) 2-8
PAP (pulmonary arterial pressure)
- systolic: 15-30
- diastolic: 5-15
PAWP (wedge) 4-12
CO (cardiac output) 4-8 L/min
CI (cardiac index) 2.5-4
RVP (right ventricular pressure)
- systolic: 15-30
- diastolic: 0-8
PVR (pulmonary vascular resistance) < 250
SVR (systemic vascular resistance) 800-1200

61
Q

The causes of a dampened waveform are the same for an art line and swan cath except for one thing, what is it?

A

A spontaneous wedge can occur in a swan, causing dampened waveform

62
Q

what is the treatment for a dampened waveform on swan?

A
  • pull cath back to RA if it has spontaneously moved forward
  • pull cath back to PA if waveform indicates a spontaneous wedge and the balloon isn’t inflated
63
Q

Causes of right ventricular waveform:

A
  • if the cath gets pulled to the right ventricle
  • RV waveform looks similar to v-tach
64
Q

Causes of no waveform:

A
  • stopcock turned off to the pt
  • catheter tip is clotted
  • monitor or system is set up incorrectly/ equipment not working
65
Q

Which intercostal space is the phlebostatic axis located

A

4th

66
Q

which reading indirectly reflects left atrial pressure and LVEDP?

A

wedge

Critical Care Paramedic (20 decks)

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