APEX Hemodynamic Monitoring Flashcards
A BP cuff that is too large ____
Decreases pressure requirement to occlude the artery
Underestimates SBP
A BP cuff that is too small ___
Overestimates BP
Ideal bladder size
Length - 80% extremity circumference
Width - 40%
Cuff location
SBP increases as cuff moves away from Aortic root, while DBP decreases, MAP stays the same
Close to the aortic root- SBP is lowest, and DBP is highest
Etiologies of an over dampened A line tracing
Air bubbles/ clot/ kinks
Low pressure in pressure bag
Ideal oscillations in A line after square test
1
Underdamped has many
Overdamped has 0
Etiologies of underdampened A line tracing
Stiff tubing
catheter whip (artifact
How far should the CVC be inserted into a RIJ? LIJ?
15cm
20cm
How far should the PA catheter be inserted into RIJ?
25-35cm
Which IJ to use and why?
RIJ
LIJ higher risk of damaging thoracic duct
Most common complication while placing heart access
Dysrhythmias
Classic presentation of pulmonary artery rupture
Hemoptysis
Catheter related infection increases after how long?
3 days
Distance from insertion site to subclavian
10cm
A, C, V waves in CVP tracing
A- atrial contraction
C- closing of the tricuspid valve
V- Passive refilling of RA
A,C,V waves in CVP, what is happening in the EKG?
A- Just after P wave
C- Just after QRS complex
V- Just after T wave
How does PEEP effect CVP?
Increases it!
Phlebostatic axis- definition and when is it used
4th IC space, mid axillary
A line / CVP
Normal CVP
1-10mmHg
What increases CVP?
PEEP
Cardiac tamponade
Hypervolemia
RVF
When should CVP be measured?
End expiration
When will A wave from CVP be increased?
Tricuspid stenosis
Diastolic dysfunction
RV hypertophy
Atria has to pump harder
What causes tall v wave?
Tricuspid regurgitation- too much fluid in atria
RV papillary muscle ischemia
When will you lose an a wave?
A fib
V pacing
Which zone should PAC be placed in?
3
How to tell if PA catheter is NOT in zone 3?
PAOP>PAD
Inability to aspirate blood when wedged
Zone 1,2,3 formulas
PA Pa Pv
Pa PA Pv
Pa PV PA
When does PCWP overestimate LVEDV
PEEP
Diastolic dysfunction
Pulmonary HTN
MV disease
When does PCWP underestimate LVEDV
Aortic valve insufficiency- thats literally it
When is thermodilution going to underestimate CO?
High injectate volume- pushing it makes injectate go to other side fast, then measurement of CO is low, think of timing
When is thermodilution going to overestimate CO?
Wedged- creates high pressure like vasoconstrictor and adds to CO falsely
Warmed- gonna open blood vessels more than normal and increase CO
Thermodilution graph
Inverse correlation between height and CO
When to use thermodilution over continuous cardiac output monitoring?
When the patient is critically ill- CCO has a delay that is unacceptable
Factors that increase mixed venous saturation SvO2
Decreased O2 consumption or increased O2 delivery
Sepsis
O2 therapy
Increased HGB
Increased CO
SNP toxicity
Factors that decrease mixed venous saturation SvO2
Increased O2 consumption or decreased O2 delivery
Anemia
Thyroid storm
Stress
Decreased CO, dec HGB, dec O2 therapy
SvO2 formula
SaO2-[VO2/ (1.34 x HGB x CO x 10)
Normal range 65-75%
How will you measure the effectiveness of a bolus with regards to fluid responsiveness
10% increase in SV from a 250 bolus
Signs of dehydration on the monitor
Pleth variation
PP variation
SBP variation
SV variation
Pulse countour analysis (for preload and thus SV) wont show reliable analysis of variation when:
PEEP- unfairly occludes pressure in the heart
small Vt- no change in return to the heart
Spontaneous Vt- big breathes occlude heart
Dysrhtyhmias
RV dysfunction
Open chest
What limits the reliability of the esophageal monitor
Aortic cross clamp
Aortic stenosis/ insufficiency
Esophageal doppler
Used for fluid management
Preload/ afterload/ inotropy
Esophageal doppler CX
Esophageal disease d/t risk of traumatic injury
PA Pressure
25/10
Most accurate and inaccurate measurement by oscillometric method BP measurement?
Map
DBP
Esophageal doppler graph changes
thin to Wider- increased preload
short to Taller- decreased afterload
Short rounded to tall pointed- increased inotropy
When not to use esophageal doppler for vest results (not cx)
Aortic stenosis, insufficiency, disease, cross clamping, pregnancy (dopper hit the baby on the head)
Most common cause of acute MI
sinus tach
Increases o2 demand
decreases supply
Amio for a fib vs a flutter
Amio will convert a fib and slow rate
Amio will only slow rate of a flutter, wont convert a flutter
What is the cause of a PVC
kypokalemia hypomagnesium
Dig toxicity
SNS
MI/ infarct
Best med for symptomatic PVC
Lidocaine 1mg/kg
infusion of 1-4mg/min
What med for long qt?
beta blockers
Genetic disorder associated with MH
King Denborough
syndromes that are associated with prolonged qt
romano ward
timothy
Potential causes of 1st degree hb
athlete
age (old)
amio
POSTERIOR MI
dig
