ACE Review - Cards Flashcards
In pt with suspected Stemi, what is initial treatment
Cath lab, percutaneous intervention…angioplasty vs stent
Mitral stenosis physiologic needs
Slow heart rate. Preload.
Is the PAP in mitral stenosis falsely estimating the left ventricle end diastolic pressure to high or too low
Falsely estimates it too hi. Real value is lower
Mitral stenosis vasopressor.
Phenylephrine
how long does ck and ckmb last in a MI patient
2 days
how long does troponin last in a MI patient
10 days
what is pulsus paradoxus
an exaggerated decrease in sbp on inspiration
what cardiac conditions cause pulsus paradox
tamponade, constrictive pericarditis, heart failure
what lung problems can cause pulsus paradox
emphysema, asthma, pneumothorax
what misc caues for pulsus paradox
obesity, PE
does pna cause pulsus
no
what is associated with arterial line occlusion
prolong line, non teflon, size of radial arter, ratio of cath to radial artery, increased attempts, hematoma formation
when is an radial artery considered a thromboocclusion
it is considered time after the cath has been removed and a thrombus forms
what is the time frame for thromboocclusion of radial artery s/p cath
occurs within 48 hours after decannulation
does transfixtion aka through and through methoid increase arterial aa occlusion
no
when has heparinization of cathethers been proven useful to prevent thromboocclusion of radial aa
it is beneficial in arterial lines kept in longer than 24 hours
following cardiothoracic surgery, how many patients develop afib
30 to 60%
what are electrolyte causes for afib in ct surg patients
hypokalemia and hypomag
besided elelctrolyte abnorm, what other risk factors for afib s/p ct surg
male, age above 60, preop tachycardia, reduced post op card output, post op increase in b naturetic peptide
What is the ACC and AHA recommened about pt who just got drug-eluting stents
wait for 1 year after placement for elective surgeries
how much risk reduction do we see with delaying elective surgerys s/p placement of drug eluting stents
50% reduction…from 6.4 to 3.3% of cardiac injury
what is the risk of having surgery after having a stent placed
the antithrombotic will be stopped and pt is at increased risk of thrombosing the stent
what is the moa of rethrombosing the stent
lack of time for re-endothilization, procoagulant state induced by stress of surgery, rebound of procoagulant state after stopping dual antithrombotic drugs
what drugs are used in dual antiplatelet therapy for stented patients
aspirin and clopidogrel
how long should dual antiplatelet therapy be used for metal stents
1 month
how long should dual antiplatelet therapy be used for drug-eluting stents
12 months
what if the surgery is an emergency and pt has a stent…what should be done to the antiplatlete drugs
continuation of asa and stop the clopidogrel
what if the surgery is urgent…how should the antiplatelet drugs be dealt with
continue of asa and stop the clopidogrel 5 days prior to surgery
in mitral prolapse, what can help you see if a normal ef is really normal
a decrease in cardiac output can tell you how severe the regurge is
is tachy or brady bad for mitral regurge
brady is bad because the heart spends more time in systole
what is the managment goal of mitral regurge
decrease svr, increase heart rate
what virus are tested in donated blood
hiv1 hiv 2 human tcell lymphocyte virus 1 and 2, westnile virus, hep b and c, syphillus
is cmv tested for in donated blood
no
what is the first line of screening of blood for infectious agents
pre donation period…by a questionaire…eliminates 90% of infected donnors
why do we not screen for cmv
50-80% adults carry cmv..sero conversion for cmv is 0.33% if infected w/ blood transfusion
which pt must require cmv screening of blood before transfusion
immunocomp, neonates and pregnant pt because of serious cmv mannifestation if infected
what is hcm
hypertrophich cardiomyopathy
should you use nitroglycerine on hcm
no, it vasodilates and decreases svr..drecreasing preload…causing lvot obstruction
should you use ephedrine in hcm
no, it increases svr and preload, but acutally also increases contractility and my worsen lvot obsruction
what is milrinone
phosphodiesterase III inhibitor
how does milrinone work
it increases contractility and decrease svr
would you use milrinone in hcm
no,
what is a good drug to tx hcm assoc hypotension
betablock
what is hcm aka
idiopathic hypertrophic subaortic stenosis, assymetrical septal hypertrophy and hcom,
how does hcm cause lvot obstruction
it is the anterior leaflet of the mitral tha comes into contact with the anterior segment of the left ventricle to cause obstruction
how to treat hcm
volume and increse svr w phenylephrine and betablockade
what are signs of arterial cannula induced dissection
high inflow arterial cath pressures, minimal
during a dissection 2ndry to cannula, how should bp be maintained?
lowest viable map should be done to prevent further dissection
what should be done after dissection is diagnosed
a distal cannulation should be done, usually at the femoral artery
after femoral cannulation is done, what is done next
systemic hypothermia and circulatory arrest and repair of the aortic dissection
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what are the classifications for aortic dissection
stanford and debakey
what is the debakey classification of aortic dissection
I, II, IIIA, IIIB
what is debakey I aortic dissection
totall involvement of aorta
what is debakey II aortic dissection
ascending aorta involvement
what is debakey IIIA aortic dissection
originating at descending aorta, extends to diaphram or extends to arch of aorta
what is debakey IIIB aortic dissection
originating at descending aorta, extends past diaphram or extends to arch of aorta
how is the stanford classification of aortic dissection
type a and b
what is standford type a disscetion of aorta
involvement of aortic arch
what is standord type b dissection of aorta
confined to the descend aorta, not passing left subclavian
what is a common pathology of stanford type a
percardial effusion
does the pericardial effusion of stanford type a cause tamponade
not always lead to tamponade, effusion is more common
can you treat the pericardial effusion of stanford type a dissection with a pericardial centesis
no, not advised…because it will promot a pressure gradient…less in the pericardial space that may allow dissection to extend down further into the aortic root
what is the mainstay treatment for hcm in pregnant patients
metoprolol
are there risk with using beta blocker in hcm pregos?
there are concerns for IUGR and fetal bradycardia, however risk is low compared to benefit of controling maternal hcm
what is the goal for hcm treatment of pregos
prevent aortocaval compression, slow sinus hr, volume, maintain svr, prevent increase iontropy
can neuraxial approach be used in hcm pregos
yes…but careful titration of local anesthestic to prevent sympathectomy
which kind of neuraxia approach is better for hcm pregos
epidural bc that can be titraed…versus one shot spinal that can lead to decrease svr and reflexive tachycardia
what is the pressor of choice for hcg pregos
phenylephrine
what is added to blood during a TEG to get blood to clot
kaolin
how do you measure R time
from the beginning of the test to the start of coagulation
what does R time represent
coagulation factors
what is K time
it is the beginning of clotting time to the time where coagulation reaches 20mm amplitude
what does k time represent
clot kinetics
how is alpha angle measure
it is the angle made by the baseline and the line tangent to the coagulation curve
what are the things that alpha angle measure
acceleration of fibrin formation and the fibrin crosslinking process
what is the max amplituide of the TEG measure
clot stregnth, aka, platelet funx
what is the ly30
it is the max amplitude minus the amplitude s/p 30 mins
what does ly30 mean
it measures fibrinolysis
how many pacemaker codes are there
- XXXXX
what is the first code of the pacemaker
which chambers are paced. A, V, D, or O (none)
what is the second code of the pacemaker
it is which chamber is sensed AVD or O
what does sensed mean
if the pacemaker recognizes the intrinsic rate of the chamber
what is the third code of the pacemaker
it is the response to the sensed chamber
what are the 3 responses of a pacemaker to the sensed chamber
I for inhibit, T for trigger, or O for no response
what happens when there is a D in the third code of the pacemaker, such as DDD
if there is a sense of atrial activity, there will be inhibition of the atrium
what is the 4th code of the pacemaker
it is the rate modulation of the pacemaker
what is rate modulation
it allows the rate of the paced chamber to change to vibration, motion, and minute ventilation
what are the 2 values of the 4th pacemaker code
R or O
what equation do you use to understand cardiac wall tension
LaPlace’s law
what is Laplaces law
Tension = Pressure x Radius /2Wall thickness
if a mycardium is thickened, is tension increase or decrease
decrease, because it is inversely proportional to tension
why is understanding wall tension for heart important
because increase tension increases o2 consumption
what cardiac pathology has a treatment dependant on laplace’s law
dilated cardiomyopathy 2ndry chf
what is the goal of treating chf?
diuresis and venodilation to decrease cardiac radius and prevent further thining of cardiac wall
What to do in vtach
Determine if it is stable or not.
What to do in stable v tach
Administer IV Amiodarone
What use to be the recommended med for stable v tach
Lidocaine
At what point does vtach become unstable.
When there is no pulse
What is the treatment of choice for pulseless vtach
Synchronized cardio version
What is a vtach that is polymorphic rather than monomorphic
Torsades
How do you treat torsades
Magnesium
What is another name for torsades
Polymorphic ventricular tachycardia
What is the danger sign when ventricle tachycardia becomes unstable
One ventricle fibrillation occurs
Why do you have to use synchronized cardioversion for ventricle tachycardia
Synchronizing your shock will prevent shocking during the refractory phase
What happens if shocks are delivered during the refractury phase
Ventricular fib
What kind of shock is used for vfib
Defibrillation, a higher current requiring shock, not synchronized
What to do if defibrillation is used for v fib and it fails
Give vasopressin
Where is the arterial and venous cannulations in a cabg
The aorta after the aortic clamp is the arterial cannulation. The right atrial appendage is the venous cannulation.
Where is the anterograde cannulation of cabg
It is between the aortic valve and the aortic clamp. This will give paraplegic medications to the coronary arteries
What valvular abnormalities will make the anterograde cannulation inefficient
Aortic insufficiency. The valve does not close and all the cardioplegic meds go to the left ventricle instead of the coronary arteries
What is the retrograde cannulation.
It is through the right atrial into the coronary sinus
Where is the cannula during retrograde infusion if you loose pressure
It is in the right ventricle….out of the coronary sinus
What happens to the arterial like systolic pressure as you move more peripherally
Increase in pulse pressure - increase in sbp
What happens to more peripheral a line upstrokes
Delayed
What happens to the dicrotic notch in more peripheral a lines
Delayed, more slurred
What happens to the diastolic wave of a more peripheral a line
More prominent
How many types of shock are there
4
What are the 4 types of shock
Cardiogenic, hypovolemic, distributive, obstructive
What are 3 numbers to look for to determine shock
Cvp, paop, svr
What numbers would you see in hypovolemic shock
Low cvp, low paop, high svr
What numbers would you. See in right sided heart failure shock
Normal cvp, normal paop, high svr
What numbers would you see in left sided heart failure
Elevated cvp, elevated paop, high svr
What numbers in biventricular failure
Everything is elevated
What numbers do you see in distributive shock
Look at the svr. It is always decreased
What are examples of distributive shock
Anaphylaxis, spinal shock, sepsis, corticosteroid insufficiency…all lead to peripheral vasodilation
What are examples of obstructive shock
Tamponade, pulm embolism, tension pneumo
What happens when the diastolic pressure equal that of the chamber pressures
Sign of cardiac tamponade
Cardiac tamponade…what is severely reduced in tamponade
Diastolic filling.
Cardiac tamponade…what is the result of decrease diastolic filling in tamponade on a cvp line
Decrease in y descent or even absent
Cardiac tamponade…what happens to the pressures on a cvp
Equalization of right atrial pressure, pulm artery diastolic pressure, and pcwp.
Cardiac tamponade…what is the triad we see
Becks triad….hypotension, increase cvp,and distant heart sounds
Cardiac tamponade…what happens to systolic pressure on inspiration
Decrease on inspiration,,,aka…pulsus paradoxus
Cardiac tamponade…what are the EKG findings
Low voltage on qrs and electrical alternans
Cardiac tamponade…can you give the patient opiod or benzo before the pericardial centesis
No…they will have sympathy lysis and thus decease heart rate and then hypotension. These patients are dependent on tachycardia
Cardiac tamponade….what is a safe form of sedation for tamponade
Ketamine…it will increase sympathetic…as well as as maintains pts ability to creative negative pressure inspiration…positive pressure ventilation has a tendency to decrease preload and cause arrest
What is the most common cause do sudden cardiac death in teens
Hypertrophic cardiac myopathy
Hcm…what is the inheritance pattern
Autosomal dominance
Hcm…what kind of murmur do u have.
Left lower stern all border murmur. And apex murmur.
Hcm…what increases the murmur
Decease preload by Valsalva maneuver.
Hcm…what decreases the murmur.
Increase preload aka squatting position.
Hcm…how do u diagnose it
Tte…left ventricular wall greater than 15mm without enlarged ventricle cavity
Hcm…should you pretreat the patient with benzo
Yes…it will blunt sympathetics and allow for slow heart rate and maintained svr
Mitral stenosis. What is the physiologic goals for anesthesia
Slow heart rate and increased svr
Mitral stenosis. Why do u want high svr
Because a drop in svr will cause a reflex tachycardia
Mitral stenosis. What is the problem with tachycardia
Poor time for ventricular filling.
Mitral stenosis. What can tachycardia lead to
Atrial fibrillation.
Mitral stenosis. What is the problem with atrial fibrillation..
It leads to decrease in cardiac output because there is little ventricular filling
Mitral stenosis. What cans atrial fibrillation lead to.
Atrial fibrillation with rvr.
Mitral stenosis. What is the volume resuscitation goal for mitral stenosis
Euvolemia. Do not cause too high in central blood volume or else you can overload the right ventricle
Mitral stenosis. What is the metabolic goals for ms
Prevent hypoxia and hypercapnia. These can lead to pulmonary hypertension and then lead to right sided heart failure. This would worsen the pulmonary hypertension that is already associated with mitral stenosis.
intraop cardiac arrest. what is the most common prodromal sign
bradycardia…shows up 67% of the time
intraoperative cardiac arrest. what is the common spo2 reading before arrest
below 90 on the spo2
intraoperative cardiac arrest. what are 3 indicators of a possible cardiac arrest
hypotension, bradycardia, hypoxia
intraoperative cardiac arrest. what is the first step in management
cardiac compression
protamine. what side effects can it cause
severe hypotension, right sided heart failure, pulm htn, bronchospasm
protamine. what are independant risk factors to get allergic rxn to it
history of nph use, fish allergy, history of allergies in general
protamine. what are theoretical risks are prior use of protamine or history of vasectomy
theoretical risks are prior use of protamine or history of vasectomy
protamine. can a protamine reaction be prevented by preadmin with histamine
no
protamine. what to do if you only see hypotension
use vasopressors and fluids
protamine. what differentiates severe hypotension from non severe
check the cvp…if it is elevated, then there is significant right sided involvement
protamine. what vasopressor is used for severe hypotension in protamine reaction
epinephrine
protamine. what side effect seen with hypotension should also be treated with epinephrine
bronchospasm
protamine. when should fluids not be used to treat hypotension
when you see right vent failure on TEE…heart is dilated already, so the increase in fluids will cause worsening clinical picture.
protamine. what should be done if right heart failure is seen after protamine reaction
reinstitution of cardiopulmonary bypass
intraop mi. what is seen first, increase in pa pressures or systemic hypotension
increase in PA pressure is seen before systemic hypotension
intraop mi. why is the pa increase seen before hypotension
because diastolic dysfunction during mi occurs before systolic dysfunction. decrease cardiac compliance occurs and back pressure into the pulm artery occurs
intraop mi. what valvular lesion may be seen.
mitral regurge…bc papillary muscles may infarc and cause mitral regurge.
intaop mi. when the mitral regurge happens, what do u see on cvp tracing
prominent a and v waves
intraop mi. what is the most sensitive indicator of MI
TEE
intraop mi. if ekg changes is seen and pap increase…but no hypotension…what drug is given
nitroglycerin…to decrease preload to heart to decrease right ventricle straing…and secondly, it dilates coronary arteries to increase coronary blood flow
pacemakers with defibrillators. what does placing the magnet do to it
it will stop the defibrilator from functioning
pacemaker with defibrillators. so what happens to a ddd pacemaker with defibrillator function
it will become ddd without a defibrillator function
pacemaker with defibrillators. what should you look at first to know what to do.
look at the interrogation…see if the patient is pacemaker dependant (seen in pts with no intrinsic cardiac conduction left)
pacemaker with defibrillators. what mode should the patient be placed in if they are pacemaker dependant
asynchronous mode…like doo or voo
pacemaker with defibrillators. how is a pacemaker placed in doo or voo
magnet does not do this…magnet only turns off the defibrillator…the pacemaker must be reset by cardiology to go into voo or doo
pacemaker with defibrillators. why should a pacemaker dependant pt be placed into asynchronous mode
assuming that the magnet has turned off the defibrillator, the pacemaker could still be in a mode where the inhibitor function may still function and get electrocautery interference …such as ddd modes of pacemaker that still has inhibition function after a magnet is placed
mediastinoscopy. what must be available for all these cases
blood for transfusion
mediastinoscopy. what is the biggest risk for these cases
bleeding.
mediastinoscopy. what may be the cause of bleeding
pulm vv, pulm aa, thoracic duct, innominate vv
mediastinoscopy. what nerve injury may be seen
phrenic nerve or recurrent laryngea nerve injury
mediastinoscopy. what lung injury may be seen
pneumothorax, or air embolism
mediastinoscopy. what limb should be monitored by what
pulse ox or arterial line should be placed on the right side because the innominate compression is commonly compressed during the case.
valsalva maneuver. how many phases are there for hemodynamic changes
four
valsalva maneuver. what happens in phase 1
the maneuver is initiated with increase in intrab pressure causing increase in preload…the heart reflex bradys
valsalva maneuver. what happens in phase 2
valsalva is maintained and now there is a decrease in preload and reflex tacycardia occurs
valsalva maneuver. what happens in phase 3
valsalva maneuver is stopped and now pulm vv capacitance is increased….less go to the left atrium and even more tachycardia occurs
valsalva maneuver. what happens to phase 4
over shoot. now massive tachycardia and preload occurs and cardiac out and bp are at its highest
valsalva maneuver. what medical condition can u diagnose using this
diabetic autonomic dysfunction. they wouuld not be able to do the reflex tachycardia. heart failure pt would also not show the overshoot
Mitral stenosis. What is the heart sound that you hear.
Loud s1 (opening snap) and a mid diastolic rumble.
Mitral stenosis. What diseases can cause this.
Rheumatic fever, sle, amyloidosis.
Mitral stenosis. What is the best physiologic conditions for this disease.
Slow and squeeze.
Mitral stenosis. What can cause chf in mitral stenosis.
Disease states that cause tachycardia and hypotension. Like thyrotoxicosis, anemia, or sepsis.
Mitral stenosis. What is the danger in tachycardia in mitral stenosis.
atrial fibrillation
cardiogenic shock. what is the most common risk factor
myocardial infarction…mainly ST elevated MI!
cardiogenic shock. when does it occur after mi
50% of patients show shock signs at 6hrs…and 75% show it within 72hrs
cardiogenic shock. at what age are pt more prone to get card shock
71 years old
cardiogenic shock. males vs females…who are more prone
females
cardiogenic shock. what infarc is more prone to shock
anterior infarct
cardiogenic shock. what kinda ekg finding makes pt risk for shock
left bbb
cardiogenic shock. what is necessary for diagnosis
you need evidence of end organ hypoperfusion…oliguria, altered mentation, severe peripheral vasoconstriction
cardiogenic shock. what value of cardiac index dictates cardiogenic shock
end organ hypoperfusion must be diagnosed first….then cardiac index can be used to help establish the diagnosis. with no pressor, a CI less than 1.8, with pressors, a CI less than 2
cardiogenic shock. if you already have signs of hypoperfusion. what bp reading can establish the diagnosis
for 30min or greather, sbp 80-90 or less,…or map in 30s
cadiogenic shock. what must u not have to diagnose cardiogenic shock
there must be no hypovolemia
cardiogenic shock. what is the foundation treatment for this
intaaortic ballon pump
cardiogenic shock. balloon pump. when does it inflate
during diastole to increase systemic diastole pressure
cardiogenic shock. balloon pump. when will it not improve coronary perfusion
if there was coronary stenosis
cardiogenic shock. what does balloon pump do to afterload
it decreases it
Prophylaxis infective endocarditis . What is the purpose of prophylaxis.
It is to prevent infections in those who would have great medical detriment if infection happens
Prophylaxis infective endocarditis. What is better at preventing infection in pt getting oral procedures.
Oral hygiene is better than antibiotics itself. The risks of of antibiotics is greater than that of the benefits of just prophylactically getting it
Prophylaxis infective endocarditis . What cardiac condition that has not had intervention should get prophylaxis.
Those of cyanosis disease should get it because these patients would die if infection occurs.
Prophylaxis infective endocarditis. What cardiac conditions that has had intervention done need prophylaxis.
Those who have valvular hardware or valvulopathy or prosthetics or those who had congenital heart problems that still have residual defects.
Prophylaxis infective endocarditis. What pmhx would indicate prophylaxis.
If the patient has history of infective endocarditis
Prophylaxis infective endocarditis. What 2 kinds of surgery do not need prophylaxis
Gu and gi interventions do not need prophylaxis for infective endocarditis purposes
Prophylaxis infective endocarditis. What are the 3 types of surgeries most associated with bacteremia
Skin musculoskeletal surgeries, oral surgeries, lung surgeries
Prophylaxis infective endocarditis. If a cyanosis heart disease was repaired but without hardware placement. Should u still prophylax
Only if the intervention has been less than 6 months ago.
Cardiac transplant. How should the volume status of the pt be kept under ga
The patients heart are de-enervated. They usually can’t raise heart rate sufficiently to compensate for hypovolemia. They are volume dependent pts. Keep them euvolemic. Do not restrict fluids and treat them like heart failure pts.
Cardiac transplant. How do u increase the heart rate in these patients.
Epinephrine or isoproterenol.
Cardiac transplant. Why do u have to monitor st-segment during surgery for these patients.
Bc transplant pt is very prone to getting cad. Their chronic steriods for immunosuppression may pedispose them to htn and diabetes.
Cardiac transplant. If a pt is on immunosuppressants, should u avoid giving them steriods in the case?
No. Some of the immunosupressants are steriods to prevent rejection of the heart. Avoiding steriods will not improve their infection rate…actually they may require stress dose steriods bc they are usually. Chronic steroid users.
mitral regurgitaiton. if there was an ischemic event. what is the most common mechanism of action for mitral regurge to develop
after cardiac infarc…remodeling occurs and causes distortion of the myocardium and annulus of the mitral valve…this causes mitral regurg…this mech is more common than papillary rupture
mitral regurgitaiton. ischemic form. what is the severity of mitral regurge needed to have exercise induced pulmonary edema
any amount of mitral regurge can cause pulm edema associated with exercise. any high level of catecholamine states may cause dysrythmia that can cause mr to be exacerbated
mitral regurgitation. ischemic form. what are good medications to use to prevent remodeling
beta blockers and ace inhibitors.
mitral regurgitation. ischemic form. what interventions can be done to reduce mr
biventricular pacing can help reduce distortion upon the mitral valve
lbbb. what do u look out for first on ekg.
must look for qrs greater than 0.12 seconds
lbbb. where is st depression and twave inversion
I v5 v6
lbbb. where is st elevation upright t wave
v1 v2
rbbb. what do u look out for first on ekg
qrs greater than 0.12
mitral stenosis. what is the normal valve area
4-6 cm2
mitral stenosis. what is considered mild stenosis
any value between 2 and 4 cm2
mitral stenosis. what is considered severe mitral stenosis
less than 1cm 2
mitral stenosis. what are they at risk for
since there is low forward flow, the stasis makes clots can can make emboli
aortic stenosis. valve area. mild/mod/sever
> 1.5cm2, 1.5-1.0, <1.0
aortic stenosis. gradient mmHg. mild/mod/severe
40
aortic stenosis. jet velocity. m/s mild/mod/severe
4
persistent left SVC. where does this left svc drain into
directly into the coronary sinus
peristent left svc. why does it drain into the coronary sinus
because this is a where embryonically at 8 weeks it is joined to drop venous drainage to the right side of the heart
perisstent left svc. where does the left side of the svc drain in normal people
in normal people, an innominate vv would form at 8 weeks…connecting both right and left caval viens. the left svc that would connect to the coronary sinus would then dissentegrate
persistent left svc. what happens to cardioplegia
cardioplegia placed for retrograde cannula might not work so well because blood would rather go up toward the left svc rather than down the coronary sinus
oxygen consumption. what is oxygen delivery
DO2
oxygen consumption. what is the equation for oxygen delivery
DO2 = CO X CaO2 X10
oxygen consumption. if u plug in all normal values for calculating oxygen delivery, what is the average value u get
about 988ml O2/min
oxygen consumption. what does an SVO2 of 75% mean
that your consumption of oxygen is only 250cc/min…aka 25% of your DO2 because 250cc/988cc is roughly 25%
oxygen consumption. how does cyanide affect svo2
it increases SVO2 because mitochondria are not able to utilize oxygen and extract it off the rbc
oxygen consumption. what kind of shunt will cause a decrease in svo2
a left to right shunt …
oxygen consumption. what does an av fistula do to svo2
decreases it
