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PTT Didactics > Cardiopulmonary Events PTT CA2 > Flashcards

Cardiopulmonary Events PTT CA2 Flashcards

1
Q

What is a normal CVP?

A

0 - 8 mmHg

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2
Q

What is a normal PCWP (Pulmonary Capillary Wedge Pressure)?

A

5 - 12 mmHg

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3
Q

What is a normal Cardiac Output?

A

4 - 6 L/min

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4
Q

What is a normal Cardiac Index?

A

2.5 - 4.2 L / min / m2

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5
Q

What is a normal SVR?

A

770 - 1500 dynes / sec / cm5

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6
Q

What is a normal PVR?

A

40 - 140 dynes / sec / cm5

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7
Q

List the Parameters of Hypovolemia

CVP

HR
PAP

ART
CO

SVR

A

List the Parameters of Hypovolemia

CVP - Low

HR - High
PAP - Low

ART - Low
CO - Low

SVR - High

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8
Q

List the Parameters of Sepsis

CVP

HR
PAP

ART
CO

SVR

PVR

A

List the Parameters of Sepsis

CVP - Low

HR - High
PAP - Low

ART - Low
CO - High

SVR - Low

PVR - Low

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9
Q

List the Parameters of CHF

CVP

HR
PAP

ART
CO

SVR

A

List the Parameters of CHF

CVP - High

HR - (Dependent on situation)
PAP - High

ART - Low
CO - Really low

SVR - High

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10
Q

List the Parameters of Peripheral Hypertension

CVP

HR

ART
SVR

A

List the Parameters of Peripheral Hypertension

CVP - Low

HR - Low

ART - (High)

SVR - High

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11
Q

List the Parameters of Pulmonary Hypertension

CVP
PAP

ART

PVR

A

List the Parameters of Pulmonary Hypertension

CVP - High
PAP - High

ART - Low

PVR - High

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12
Q

What are the hemodynamic parameters of Tamponade for:

CVP

HR
PAP

ART
CO

A

What are the hemodynamic parameters of Tamponade for:

CVP - High

HR - High
PAP - High

ART - Low
CO - Low

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13
Q

What is the treatment for Septic Shock?

A
  1. Norepinephrine (A1, A2 and B1 agonism)
    - Helps combat your low SVR and has some ionotropy
  2. Vasopressin
  3. Phenylephrine (Helps with SVR but does drop your CO)
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14
Q

What is the treatment for acute CHF?

A
  1. Dobutamine (B1 agonist)
  2. Dopamine

<3 mcg/kg/min DA1 agonist

5 - 10 mcg/kg/min B1 and B2

10 - 20 mcg/kg/min Alpha agonism

  1. Epinephrine

<3 mcg/min - Beta 1 and Beta 2

> 3 mcg/min - Alpha receptors are recruited

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15
Q

What is the treatment for Peripheral Hypertension?

A

1. Nitroprusside

Reduction in (Afterload > Preload)

50 - 100 mcg (0.5 - 3 mcg/kg/min)

2. Nitroglycerine

Reduction in (Afterload < Preload)

50 - 100 mcg (0.5 - 3 mcg/kg/min)

3. Nicardipine (CCB)

5 - 15 mg/hr

1-4 mcg/kg/min

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16
Q

What is the mechanism of action of nicardipine?

A

By deforming the channel, inhibiting ion-control gating mechanisms, and/or interfering with the release of calcium from the sarcoplasmic reticulum, nicardipine inhibits the influx of extracellular calcium across the myocardial and vascular smooth muscle cell membranes.

The decrease in intracellular calcium inhibits the contractile processes of the myocardial smooth muscle cells, causing dilation of the coronary and systemic arteries, increased oxygen delivery to the myocardial tissue, decreased total peripheral resistance, decreased systemic blood pressure, and decreased afterload.

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17
Q

What is the treatment for pulmonary hypertension?

A
  1. Dobutamine with Nitroglycerine
    - Dobutamine Dose 3 - 20 mcg/kg/min or 0.2 - 1.4 mg/min
  2. Milrinone
    - 0.2 - 0.75 mcg/kg/min
  3. Nitric Oxide
  4. Prostaglandin E1
18
Q

What is the treatment for tamponade?

A
  1. IVF (Possibly)
  2. Iontropes (Possibly)
  3. Avoid High Airway Pressures
19
Q

What are the components of myocardial oxygen supply?

A

1. Coronary Anatomy

Obstruction (CAD) vs. Spasm (Variant angina) vs. Extraluminal Compression (Anomalous Coronaries)

2. HR

Diastolic Time

3. Perfusion Pressure of the Coronaries

Left CPP = DBP - LVEDP

Right CPP = DBP - RVEDP

4. Arterial Oxygen Content

amount of oxygen bound to hemoglobin (1.34 * Hb * SaO2) plus the oxygen dissolved in plasma (0.0031 * PaO2)

Hypoxemia

Anemia

20
Q

What are the components of myocardial oxygen demand?

A
  1. Tachycardia
  2. Wall tension
  3. Contractility
21
Q

What are the components of Wall Tension?

A

This relationship is similar to the Law of LaPlace, which states that:

Wall tension (T) is proportionate to the pressure (P) times radius (r) for thin-walled spheres or cylinders. Therefore, wall stress is wall tension divided by wall thickness.

The exact equation depends on the cardiac chamber shape, which changes during the cardiac cycle; therefore, a single geometric relationship is sometimes assumed. For this reason, the above relationship is expressed as a proportionality to highlight how pressure, radius and wall thickness contribute to afterload.

22
Q

Pulmonary capillary wedge pressure (PCWP) is used as a surrogate of what?

A

Pulmonary capillary wedge pressure (PCWP) is used as a surrogate of LVEDP

23
Q

What is the arterial oxygen content equation and normal value?

A

(Hgb * 1.31 * SaO2) + (0.003 * PaO2)

CaO2

20 ml O2/dL blood

24
Q

What is the mixed venous oxygen content equation and normal value?

A

(Hgb * 1.31 * SvO2 ) + (0.003 * PvO2)

CvO2

15 ml O2/dL blood

25
Q

What is the pulmonary capillary oxygen content equation and valve?

A

Hgb * 4/3 * 1 (0.003 * PAO2)

CcO2 = 21 mL O2/dL blood

26
Q

What is the value and equation for Oxygen Delivery?

A

Content of O2 x Cardiac Output

DO2

640 -1000 ml O2/min

CO*Hgb*1.31*SaO2 or CO*CaO2

27
Q

What is the equation for Oxygen consumption?

A

VO2 = 250 mL O2 per minute

CO* Hgb * 1.31 * (SaO2 - SvO2)

28
Q

What are some indications for arterial line placement?

A
  1. Need to monitor blood pressure beat to beat
    - Gradual vs. Acute
    - Expected hemorrhage
  2. Surgical Indications
    - Cardiac Surgery
    - Circulatory Arrest
  3. Intraoperative
    - Hypertensive crisis
    - Use of vasoactive drugs such as dopamine, nitroglycerin, etc
  4. Shock
  5. Lab draws - Frequent ABG’s or other blood work
29
Q

What are the contraindications for an arterial line?

A

Raynauds disease

30
Q

What are the indications to establish Central Line access?

A
  1. No PIV access
  2. Transvenous Pacing
  3. Vasoactive Medications
  4. Hemodynamic monitoring (Right sided filling pressures via CVP)
  5. Myocardial Biopsy following transplant
  6. Air Embolism for sitting craniotomy
31
Q

What are relative contraindications for central line placement?

A

1. Coagulopathy

2. Newly inserted pacemaker wires

32
Q

What are the potential complications for central line placement?

A

1. Arrythmias

2. Endobronchial hemorrhage

3. Thrombus formation

4. Incorrect Placement (Carotid or mediastinum)

5. Detached pacing wires

6. Erroneous interpretation of the data

33
Q

What are the reasons to put in a pulmonary artery catheter?

A

Patient Pathological Indications:

  • Measures of Right Sided Filling Pressures are inadequate to estimate Left Sided Filling Pressures (Conditions of LV failure, RV Failure, pulmonary vasculature disease, severe valvular disease)
  • Patients with recent myocardial infarctions or unstable angina
  • Patients with recent myocardial infarctions or unstable angina
  • Shock (Hypovolemic, cardiogenic, or septic shock) with MODS
  • Massive trauma
  • Patients with right-sided heart failure, chronic obstructive pulmonary disease, pulmonary hypertension, or pulmonary embolism

Surgical Indications:

  • Large fluid shifts or Blood Loss (CAD or deceased LV function)
  • Procedures requiring cardiopulmonary bypass
  • Surgery of the aorta requiring cross clamping
  • Patients requiring high levels of positive end-expiratory pressure
  • Hemodynamically unstable patients requiring inotropes
  • intraaortic balloon counterpulsation
  • Hepatic transplantation
  • Massive ascites requiring major surgery
34
Q

What are the absolute contraindications to PA Catheter?

A
  • *Contraindications ABSOLUTE**
  • Tricuspid or pulmonic valvular stenosis
  • Right atrial or right ventricular masses (tumor or thrombus)
  • Tetralogy of Fallot
35
Q

What are the relative contraindications to PA Catheter placement?

A

RELATIVE

  • Severe arrhythmias
  • History of LBBB
  • Coagulopathy
  • Newly inserted pacemaker wires
36
Q

What are the potential complications of PA Catheters?

A

Arrhythmias
Complete heart block
Endobronchial hemorrhage
Pulmonary infarction
Catheter knotting and entrapment
Valvular damage
Thrombocytopenia
Thrombus formation

Incorrect placement (esp. carotid artery – high risk of stoke)

Catheter electrode detachment of pacing catheters
Risk for perforation with pacing wires
Erroneous interpretation of data

37
Q

How do you assess preload via echo?

A

Preload look at Transgastric Short Axis = End Diastolic Area

Normal preload: 16 cm2

Low Preload: Kissing Papillary muscles (empty in diastole)

High Preload: Area > 16 cm2 (dilated LV)

38
Q

How do you assess contractility on Echo?

A

Endocardial Excursion = Change in radius of 30%

Myocardial Wall Thickening = Change of 30 - 50%

39
Q

How do you grade segmental wall motion abnormalities?

A

Segmental Wall Motion:

1 normal
2 hypokinetic

3 severe hypokinetic

4 akinetic
5 Dyskinetic

40
Q

Draw out the wall segments in the transgastric short axis view

A

11 to 12:30: Inferior Wall (RCA)

12:30 to 2 Posterior Wall (Cx)
2 to 4:30 Lateral Wall (Cx)
4:30 to 7 Anterior Wall (LAD)

7 to 9 Anteroseptal Wall (LAD)

9 to 11 Septal Wall (LAD)

41
Q

How do you assess afterload on echo?

A

End Systolic Area

Normal: 6-8 cm2

Low: <6 (LV empties all the way)

High: >8 (LV doesn’t empty out)

42
Q
A

PTT Didactics (12 decks)

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