Advanced Hemodynamic Monitoring

Question 1

Cardiac Index Normal Value

Answer 1

2.2-4.2 L/min/m^2

Question 2

Central venous pressure CVP normal value

Answer 2

5-12 mmHg

Question 3

when is CVP most accurately measured?

Answer 3

end of expiration

Question 4

in what patient position is CVP considered NOT accurate?

Answer 4

if a patient is sitting

should be backrest from 0-60 degrees

Question 5

coronary perfusion pressure normal value

Answer 5

50-120 mmHg

Question 6

mixed venous oxygen saturation (mvO2) normal value

Answer 6

60-80% in awake pt

roughly equal to central venous oxygen saturation (ScvO2)

Question 7

pulmonary artery pressure (PAP) normal value

Answer 7

15-30/10 mmHg

not as accurate when sitting

Question 8

mild pulmonary Htn value of PAP systolic

Answer 8

36-49 mmHg systolic

Question 9

moderate pulmonary Htn value of PAP systolic

Answer 9

50-59 mmHg systolic

Question 10

severe pulmonary Htn value of PAP systolic

Answer 10

> 60 mmHg systolic

Question 11

pulmonary capillary wedge pressure (PCWP) normal value

Answer 11

less than 12mmHg

not considered accurate if sitting

Question 12

PCWP is _____ mmHg less than pulmonary artery diastolic pressure

Answer 12

1-4mmHg

Question 13

pulmonary vascular resistance (PVR) normal value

Answer 13

100-300 dynesseccm-5

Question 14

stroke volume normal value

Answer 14

60-90mL/beat

Question 15

stroke volume index normal value

Answer 15

20-65mL/beat/m^2

Question 16

systemic vascular resistance (SVR) normal value

Answer 16

700-1200 dynesseccm-5

Question 17

central venous O2 saturation (ScvO2)

Answer 17

25-30% below patients SaO2

Question 18

what do the bainbridge and baroreceptor reflex have in common?

Answer 18

both control the heart rate

Question 19

baroreceptor reflex definition

Answer 19

responds to changes in blood pressure inside the carotid sinus and aortic arch

Question 20

bainbridge reflex definition

Answer 20

responds to changes in blood volume inside the heart

Question 21

what are the two things the bainbridge reflex causes if the right atrial pressure increases?

Answer 21

increased heart rate

vasodilation (decreasing venous return)

Question 22

what happens to the heart with a low CVP baroreceptor reflex and high CVP bainbridge reflex?

Answer 22

increase in HR for both

Question 23

What does the normal cardiac output values depend on?

Answer 23

the size of the patient

Question 24

cardiac index definition

Answer 24

allows more accurate interpretation of cardiac output b/c number is not skewed by weight

Question 25

cardiac index equation

Answer 25

cardiac output/body surface area

Question 26

assuming two patients are healthy which would differ and which would be the same? cardiac output cardiac index

Answer 26

cardiac output would differ | cardiac index would be the same

Question 27

Stroke volume index equation

Answer 27

=stroke volume/body surface area

Question 28

stroke volume index definition

Answer 28

allows more accurate interpretation of stroke volume because the number is not skewed by weight

Question 29

coronary perfusion pressure (CPP) equation 1

Answer 29

CPP= DBP-LVEDP

Question 30

how can we estimate LVEDP?

Answer 30

because it is roughly equal to systolic pressure in the left atrium (left atrial pressure) which is roughly equal to PCWP

Question 31

coronary perfusion pressure (CPP) equation 2

Answer 31

CPP= DBP - CVP

Question 32

what are the 3 estimations for LVEDP

Answer 32

~ left atrial pressure (LAP) ~left atrial pressure (LAP) ~ PCWP ~PCWP ~ PA diastolic pressure

Question 33

what are the 3 equations CPP can be estimated by?

Answer 33

``` CPP= DBP-CVP CPP= DBP- PCWP CPP= DBP- PA diastolic pressure ```

Question 34

what are the four parts to thermodilution technique

Answer 34

10mL saline injected into RA (<4sec) cold fluid travels to thermistor cold fluid is warmed to a degree monitor produces waveform based on coldness of fluid

Question 35

high cardiac output thermistor chart

Answer 35

get cold fast but warm up quickly | area under curve is lower than normal

Question 36

low cardiac output thermistor chart

Answer 36

will stay cold for longer period of time | area under curve is higher than normal

Question 37

a factor that decreases the area under the thermodilution curve will over or underestimate CO?

Answer 37

overestimate CO

Question 38

a factor that increases the area under the curve will over or underestimate CO?

Answer 38

underestimate CO

Question 39

how is cardiac output related to the area under the thermodilution curve?

Answer 39

inversely

Question 40

what would happen if you prolonged the injection time?

Answer 40

the curve would be larger than normal which means the cardiac output reading would be underestimated

Question 41

what are the two things that have replaced thermodilution?

Answer 41

continuous cardiac output (CCO) pulmonary artery catheters | transesophageal echocardiography TEE

Question 42

central venous O2 saturation where is the blood draw from and with what?

Answer 42

oxygen saturation of blood from superior vena cava drawn from the central venous line port

Question 43

which will be lower mvO2 or ScvO2? why?

Answer 43

mvO2 | because coronary sinus blood is more deoxygenated than other blood

Question 44

what are the three things that make up mvO2?

Answer 44

superior vena cava inferior vena cava coronary sinus

Question 45

how does mvO2 and ScvO2 relate to low cardiac output?

Answer 45

lower mvO2 and ScvO2 bc the blood has more time to become deoxygenated

Question 46

how does mvO2 and ScvO2 relate to high cardiac output?

Answer 46

higher mvO2 and ScvO2 bc the blood has less time to become deoxygenated

Question 47

what are the two reasons that ScvO2 and mvO2 are rarely used anymore?

Answer 47

requires drawing blood from central line or swan | CO can be estimated by other effective methods

Question 48

Ohms law

Answer 48

V= IR

Question 49

what does ohms law describe

Answer 49

the factors that affect flow through an electrical circuit

Question 50

V=

Answer 50

voltage | MAP - CVP

Question 51

I=

Answer 51

current | analogous to cardiac output

Question 52

R=

Answer 52

resistance systemic vascular resistance or pulmonary vascular resistance

Question 53

applying ohms law to cardiac output 2 equations

Answer 53

``` CO= (MAP-CVP/SVR) (80) CO= (PAP-PCWP/PVR) (80) ```