Block 2 Flashcards
BP = what two parameters?
CO x SVR
SVR is determined by what?
Radius of resistance vessels
Cardiac = what two parameters?
SV x HR
CO
SVR
SV
HR
Which one is directly influenced by preload, contractility, and afterload?
SV
SVR is proportional to Afterload
Increase of (preload/contractility/afterload) increases SV
All except afterload
Increased afterload decreases SV
Increased afterload will INCREASE SVR though
Cardiac output adjusted for body weight is known as..?
Cardiac Index
= CO/BSA
What is preload? Afterload?
Preload = pressure/volume in ventricles as they fill up
Afterload = the pressure the left ventricles have to overcome for blood to flow, resistance to blood flow
How do fluids and vasopressors affect preload/afterload?
Fluids will increase preload (diuretics will decrease it)
Anything that causes vasoconstriction (like vasopressors) will increase afterload (so vasodilation will decrease it)
Increased preload = Increased end diastolic volume = Increased contractility except in what patients?
Heart Failure, stroke volume hardly changes
What are the 4 types of shock?
Hypovolemic
Cardiogenic
Obstructive
Distributive
Distributive
Hypovolemic
Cardiogenic
Obstructive
Which one has vasodilation?
Distributive
Distributive
Hypovolemic
Cardiogenic
Obstructive
Which one has vasoconstriction?
Hypovolemic (arterial side usually)
Distributive
Hypovolemic
Cardiogenic
Obstructive
Which one has a formation of a pericardial tamponade?
Obstruction
Distributive
Hypovolemic
Cardiogenic
Obstructive
Which one is seen in patients with possible edema?
Cardiogenic
Distributive
Hypovolemic
Cardiogenic
Obstructive
Which one is caused by ventricular failure?
Cardiogenic
CVP
PCWP
CO
SVR
How does hypovolemic shock affect these values?
Low fluid, therefore CVP and PCWP decreased
CO is down as a result, but SVR will compensate (vasoconstriction) and increase
CVP
PCWP
CO
SVR
How does cardiogenic shock affect these values?
Fluid status is usually increased, so CVP and PCWP are increased.
CO is still down as a result and SVR will compensate by increasing
CVP
PCWP
CO
SVR
How does obstructive (pericardium tamponade) shock affect these values?
Same as cardiogenic but different from PE obstructive shock
CVP
PCWP
CO
SVR
How does obstructive (systolic contraction/PE) shock affect these values?
Pretty much the same as obstructive and cardiogenic, but PCWP may decrease or be normal
CVP
PCWP
CO
SVR
How does distributive shock affect these values?
No treatment = everything decreased
With treatment = everything increased except SVR
Immediate goals of:
MAP
CI
MAP > 65
CI >2.2
Immediate goals of:
Hgb
O2 sat
Lactate
Hgb > 7
O2 sat >92%
Lactate < 2
Osmolarity equation?
2xNa + (BUN/2.8) + (Glucose/18)
Compared to NS, what does LR have?
Less sodium
Potassium
Calcium
Less chloride
Lactate
Compared to NS, what does plasmalyte-A or Normosol-R have?
Less sodium (but more than LR)
Potassium (higher than LR)
Less chloride (even less than LR)
Magnesium
Acetate
Gluconate
How does administering albumin help with fluids?
Draws fluids from extravascular/intracellular space to intravascular space
What did the SAFE trial say?
ICU patients, fluid resuscitation with albumin vs NS
No difference in 28-day mortality
Subgroup analysis with traumatic brain injury had a higher mortality with albumin (but wasn’t the focus of the trial)
Use crystalloids (NS) for initial resuscitation vs colloids)
Another study (CRISTAL) showed the same results except they did it with more crystalloids and colloids
What have studies shown about using more balanced crystalloids (LR, plasma-lyte) vs NS?
No mortality differences, but less AKI in LR, plasma-lyte groups