Advanced Hemodynamics Flashcards
Types of shock
Obstructive, Cardiogenic, Distributive, Hypovolemic, Neurogenic(a form of distributive), and Dissociative
Obstructive shock
Ex: Cardiac Tamponade, Tension Pneumothorax, PE, and Congenital heart defects
Cardiogenic shock
LV dysfunction(systolic and diastolic failure)
Distributive shock
Ex: Septic, anaphylactic, and neurogenic
Hypovolemic shock
Ex: Hemorrhagic, Volume loss, and Burn
Neurogenic Shock
Spinal cord transection
Dissociative Shock
Ex: CO poisoning, Methemoglobinemia, and Toxic metabolites
Phlebostatic axis
Mid-point between the anterior/posterior chest in the 4th inter-costal space(tape the transducer at this point)
Damping
Is the test to see how sensitive an arterial line pressures are
Central Venous Catheters
> Flexible catheters that terminate in the superior vena cava
Can have single, dual, multiple ports
usually placed in the subclavian, external jugular, femoral, or AC veins.
can draw blood from them, give blood/fluids, give meds, and give IV food(parental nutrition)
Swan-Gans catheter
> AKA the pulmonary artery catheter
at minimum, 3 ports with one being a balloon port.
Red and Yellow ports are potentially DEADLY ports! DO NOT TOUCH!!!
Red=balloon port, yellow=distal or thermistor port
Placed into vena cava through IJ, subclavian, or femoral vein.
SVR equation and normal range
(Systemic Vascular Resistance)
SVR=[MAP-CVP/Q]x80
Normal 800-1200 dynes/sec/cm-5
PVR equation and range
(Pulmonary Vascular Resistance)
PVR=[Mean PAP/Q]-PCWP x 80
Normal= 100-200 dynes/sec/cm-5
Cardiac Output(Q)
Q=(SVR-HR)/1000
Normal = 4-8L/min
Cardiac Index(CI)
Q/BSA
Normal 2-4L/min
Body Surface Area(average is 1.7m2
Numeric values for PA catheter
Central Venous Pressure(CVP or RAP) = 2-6mmHg
RV systolic = 20-30mmHg
RV diastolic = 0-5mmHg
PA systolic = 15-25mmHg
PA diastolic = 8-15mmHg(important)**
Wedge pressure = 8-12mmHg
(Pulmonary capillary wedge pressure) also seen as PCWP or PAOP
Central Venous Pressure
Used to monitor blood volume, central venous return or RV function, and administration of IV meds, fluids, blood, or TPN.
Abnormal RAP/CVP causes
> Decreased CVP- right atrial pressures, hypovolemia, or vasodilation.
Increased CVP- RV failure/infarct, tricuspid insufficiency, or COPD.
Left sided failure- left systolic failure, volume overload, pulmonary HTN, cardiac tamponade, or PEEP.
Abnormal RVP causes
> Increased RVP- RV failure/chronic CHF, pulmonary HTN/hypoxemia, or cardiac tamponade
not monitored except during PA catheter placement, not monitored during transport
Pulmonary Artery pressure(PAP)
Uses: measure PA systolic pressure(PAS), PA diastolic pressure(PAD), and indirectly reflects LV end-diastolic pressure.
PAD Can be used to estimate wedge pressure- 2-4mmHg higher than mean wedge pressure
Abnormal PAP/PCWP causes
> Decreased PAP: hypovolemia and dampened waveform
Increased PAP: fluid overload, atrial or ventricular defect, pulmonary problems(COPD or Asthma, mitral valve regurgitation/stenosis, or LV failure
Anacrotic notch vs dicrotic notch
(PA)Dicrotic notch(caused by closure of pulmonary valve) is on the right of the wave form and (RVP)anacrotic notch (indicates atrial kick) is on the left side of the wave form.
PCWP
Measured with balloon inflated.
Red port- 1.5mL of air
Indirectly reflects LAP, preload of the left side
Normal is 8-12mmHg
Abnormal PCWP causes
> decreased: hypovolemia or vasodilator meds
increased: LV failure, mitral valve disease, cardiac tamponade or fluid overload
Triangle method
*Resuscitating a shock patient
Volume—>HR—>SVR
Too much or too little fluid?
Too fast or too slow HR?
Low SVR? Vasodilated? High SVR?
When will CVP and PCWP not mirror eachother
In RIght Heart Failure
