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Sp: PMI > 17. Adv Hemodynamic Monitoring > Flashcards

17. Adv Hemodynamic Monitoring Flashcards

1
Q

cardiac index normal range

A

2.2-2.4 L/min/m2

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2
Q

CVP normal range

A

5-12 mmHg

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3
Q

when is CVP most accurately measured

A

end of expiration

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4
Q

when is CVP not considered accurate

A

pt is “sitting”

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5
Q

what degree must the pt head be resting at to be considered accurate

A

between 0-60 degrees

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6
Q

coronary perfusion pressure normal

A

50-120mmHg

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7
Q

mixed venous oxygen saturation (mvO2)

A

60-80% in awake pt

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8
Q

mvO2 is approximately the same as

A

ScvO2
(central venous oxygen saturation)

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9
Q

pulmonary artery pressure (PAP)

A

15-30/10 mmHg

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10
Q

when is PAP not considered accurate

A

if pt is sitting

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11
Q

pulmonary hypertension: mild

A

36-49 mmHg (systolic)

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12
Q

pulmonary hypertension: mod

A

50-59 mmHg (systolic)

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13
Q

pulmonary hypertension: severe

A

> 60 mmHg (systolic)

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14
Q

pulmonary capillary wedge pressure (PCWP)

A

<12mmHg (mean pressure)

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15
Q

PCWP should be _______ less than pulmonary artery ______ pressure

A

1-4mmHg less than pulmonary artery diastolic pressure

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16
Q

when is PCWP not considered accurate

A

if pt is sitting

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17
Q

pulmonary vascular resistance (PVR)

A

100-300 dynes sec cm-5

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18
Q

stroke volume (adult)

A

60-90 mL/beat

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19
Q

stroke volume index

A

33-47 mL/m2/beat

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20
Q

systemic vascular resistance (SVR)

A

700-1200 dynes sec cm-5

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21
Q

ScvO2 (central venous O2 saturation)

A

25-30% below pt SaO2
OR
70-75% if the SaO2 is normal

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22
Q

what reflex control heart rate

A

bainbridge
baroreceptor

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23
Q

baroreceptor reflex

A

responds to changes in BP

low BP = incr HR
high BP = decr HR

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24
Q

bainbridge reflex

A

responds to change in blood volume

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25
Q

2 bainbridge reflexes

A

incr BV in RA
1. incr HR (pump extra blood out)
2. vasodilation (decr venous return)

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26
Q

what causes incr in HR

A

low CVP (baro)
high CVP (bain)

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27
Q

what does cardiac output vary based on

A

the pt weight

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28
Q

normal CO for 70kg pt

A

5L/min

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29
Q

200kg pt CO

A

higher than 5L/min

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30
Q

cardiac index equation

A

CI = CO/body SA

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31
Q

the cardiac index is independent of_____

A

weight

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32
Q

normal range of cardiac index is

A

same for all pts, regardless of size

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33
Q

stroke volume varies with

A

weight

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34
Q

stroke volume index equation

A

SVI = SV/body SA

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35
Q

Coronary perfusion pressure equations

A

CPP = DBP - LVEDP
OR
CPP = DBP - CVP

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36
Q

LVEDP

A

BP in LV at end of diastole

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37
Q

what is a good estimate of LVEDP

A

LVEDP~LAP~PCWP~PA diastolic P

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38
Q

CPP equations

A

CPP = DBP - PCWP

CPP = DBP - PA diastolic Pressure

CPP = DBP - CVP

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39
Q

what is required for adequate coronary perfusion pressure

A

adequate diastolic filling time
adequate blood pressure

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40
Q

thermodilution steps

A
  1. 10mL cold saline into RA (fast <4s)
  2. thermistor located in pulmonary artery
  3. thermistor monitors fluid temp
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41
Q

thermodilution curve: high CO

A

low Area Under Curve
small wave
- cold fluid passes thermistor quickly

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42
Q

thermodilution curve: low CO

A

higher Area Under Curve
large wave
- thermistor will stay colder longer

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43
Q

CO relationship with thermodilution curve

A

CO is inversely proportional to area under thermodilution curve

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44
Q

what has replaced thermodilution

A

Continuous cardiac output PACs
TEE

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45
Q

what can cause false readings in thermodilution

A

prolonged injection time
>4s

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46
Q

a prolonged injection time would cause

A

CO reading to be underestimated

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47
Q

R-L shunt: thermodilution curve

A

fluid less cold (losing 1/2 cold)
AUC smaller
overestimation of CO

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48
Q

L-R shunt: thermodilution

A

fluid less cold (diluted)
AUC smaller
overestimation of CO

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49
Q

triscuspid regurge: thermodilution

A

fluid colder longer
AUC larger
underestimation of CO

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50
Q

ScvO2

A

O2 saturation of blood taken from SVC
drawn from central line port

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51
Q

mvO2

A

drawn from PA
- mixed sample of SVC, IVC, and coronary sinus blood

52
Q

which blood sample contains venous blood from the heart?

A

mvO2

53
Q

which blood sample will be more deoxygenated?

A

mvO2
(coronary sinus blood is more deoxy because the heart burns more O2 than other organs)

54
Q

which is lower: mvO2 or scvO2

A

mvO2 < scvO2

55
Q

low CO: mvO2 and scvO2

A

low CO = lower mvO2/ScvO2

(blood is more deoxygenated)

56
Q

high CO: mvO2 and scvO2

A

high CO = higher mvO2/ScvO2

(blood is less deoxygenated)

57
Q

mvO2 and CO correlation

A

directly proportional

58
Q

causes of Low ScvO2/mvO2

A

hypoxia
hypoventilation
incr metabolic rate (incr O2 demand)
low CO

59
Q

causes of High ScvO2/mvO2

A

decr metabolic rate (decr O2 demand)
mitochondrial dysfunction

60
Q

intubating the esophagus causes

A

decr SpO2
decr ScvO2
decr mvO2

61
Q

when can mitochondrial dysfunction occur

A

in sepsis

62
Q

how does mitochondrial dysfunction cause high ScvO2/mvO2

A

mitochondria unable to uptake O2 well
higher [O2] in blood

63
Q

Ohm’s law

A

V=IR

voltage = current x resistance

64
Q

resistance (R)

A

SVR
or PVR

65
Q

current (I)

A

CO

66
Q

voltage definition

A

difference in energy between two ends of a circuit

67
Q

voltage (V)

A

MAP - CVP

difference in BP at arterial end and the venous end

OR

PAP-PCWP

difference in BP at the pulmonary arterial end and pulmonary venous end

68
Q

Ohm’s law for CO

A

(MAP - CVP) = CO x SVR

69
Q

CO equation

A

CO = [(MAP-CVP)/SVR]x80

OR

CO = [(PAP-PCWP)/PVR]x80

70
Q

SVR equation

A

SVR = [(MAP-CVP)/CO]x80

71
Q

SVR units

A

dynes/sec/cm-5

72
Q

CO units

A

L/min

73
Q

PVR equation

A

PVR = [(PAP-PCWP)/CO]x80

74
Q

PVR units

A

dynes/sec/cm-5

75
Q

narrow pulse pressure

A

<25% of systolic pressure

76
Q

wide pulse pressure

A

> 50% of systolic pressure

77
Q

does stroke volume have a great effect on systolic or diastolic?

A

systolic

78
Q

increase SV = ______ pulse pressure

A

incr SV = incr PP

79
Q

does SVR have a greater effect on systolic or diastolic?

A

diastolic

80
Q

increase SVR = _______ pulse pressure

A

incr SVR = decr PP

81
Q

pulse pressure is ________ proportional to aortic compliance

A

inversely proportional

82
Q

aorta w/good compliance (young healthy pt)

A

systolic pressure is lower in systole

PP is lower

83
Q

aorta less compliant (older pt)

A

systolic pressure is higher in systole

PP is higher

84
Q

pulse pressure: hypovolemic pt

A

Narrow PP

decr SV = decr systolic
vasoconstriction = incr diastolic

85
Q

pulse pressure: congestive heart failure

A

Narrow PP

decr SV = decr systolic
vasoconstric = incr diastolic

86
Q

pulse pressure: post-workout

A

Wide PP

incr SV = incr systolic
vasodilate = decr systolic

87
Q

pulse pressure: cardiac tamponade

A

Narrow PP

decr SV = decr systolic
vasoconstrict = incr diastolic

88
Q

pulse pressure: aortic stenosis

A

Narrow PP

decr SV = decr systolic
vasoconstrict = incr diastolic

89
Q

pulse pressure: milrinone

A

Wide PP

incr contractility = incr SV = incr systolic
decr SVR = decr diastolic

90
Q

pulse pressure: aortic regurge

A

Wide PP

incr SV
vasodilation

91
Q

intraoperative causes of high CVP

A

fluid overload
HF
pulm HTN
Tburg
high intrathoracic pressure

92
Q

treatment: high CVP - fluid overload

A

diuretics
fluid restriction

93
Q

treatment: high CVP - HF

A

inotropes

94
Q

treatment: high CVP - pulm HTN

A

hyperventilation
higher FiO2
pulm vasodilators

95
Q

treatment: high CVP - high intrathoracic P

A

needle decompression
chest tube

96
Q

intraoperative causes of low CVP

A

hypovolemia
reverse Tburg
sitting

97
Q

treatment: low CVP - hypovolemia

A

fluid resuscitation

98
Q

causes of low SVR

A

vasodilation

99
Q

treatment: low SVR - vasodilation

A

lighten anesthetic
give vasopressors

100
Q

causes of high SVR

A

vasoconstriction

101
Q

treatment: high SVR - vasoconstriction

A

vasodilator

102
Q

causes of low cardiac index

A

decr contractility
bradycardia
hypovolemia
hypervolemia (CHF)
incr afterload
- aortic stenosis
- high SVR

103
Q

causes of high cardiac index

A

incr contractility
incr SV
tachycardia
vasodilation
(decr afterload = incr SV)

104
Q

symptoms of HF

A

low cardiac index
hypotension
incr SVR
pulm HTN (pulm edema)
high CVP

105
Q

what does the body do when CO is low

A

vasoconstricts to prevent BP from getting too low

106
Q

treatments for HF

A

inotropes
diuretics

107
Q

hypotension due to hypovolemia

A

CI: low
CVP: low
SVR: high

108
Q

hypotension due to vasodilation

A

CI: high
SVR: low

109
Q

hypotension due to decreased contractility

A

CI: low
CVP: high
SVR: high
PAP: high

110
Q

stroke volume variation

A

SV fluctuation between inspiration and expiration
(AKA PPV)

111
Q

in spontaneously ventilating pts, SBP __________ during inspiration

A

in spontaneously ventilating pts, SBP decreases 5-10mmHg during inspiration

112
Q

why does SBP decrease during inspiration for SV?

A

Pulm vessels vasodilate
blood pools in legs
decr preload
decr BP

113
Q

in mechanically ventilated pts, SBP _________ during inspiration

A

in mechanically ventilated pts, SBP increases 5-10% during inspiration

114
Q

why does SBP increase during inspiration for mechanical ventilation?

A

lungs inflate
pushes LV wall inward during systole
incr EF
incr blood volume/SV

115
Q

SV/SBP has wider fluctuations during insp/expir

A

pulsus paradoxus

116
Q

pulsus paradoxus SBP

A

SBP decr >10mmHg for spontaneous inspiration
SBP incr >10-15% for mechanical inspiration

117
Q

causes of pulsus paradoxus

A

hypovolemia
cardiac tamponade
pneumothorax

118
Q

how does cardiac tamponade/tension pneumo cause pulsus paradoxus?

A

inspiration
incr BV in RV
RV cannot expand
interventricular septum pushes into LV
decr volume of LV
decr SV
decr BP

119
Q

EV1000/Flo Trac monitors

A

beat to beat BP
SVR
CO
SV/SVI
SVV

120
Q

EV1000/Flo Trac uses ______ for CVP

A

7mmHg

121
Q

monitor volume status

A

urine output
hypotension/tachycardia
CVP

122
Q

what is the FloTrac good for

A

fluid management
High SVV ~ hypovolemia

123
Q

Flo Trac limitaitons

A

requires mech venitloation
fixed RR
TV > 8ml/kg
regular heart rhythm
SVV altered by PEEP/vasodilators

124
Q

pulsus alternans

A

variation in BP every other beat

125
Q

causes of pulsus alternans

A

severe ventricular dysfunction

126
Q

electrical alternans

A

alternation of QRS between beats

127
Q

causes of electrical alternans

A

cardiac tamponade
myocardial infarction

Sp: PMI (18 decks)

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