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Hemodynamics > Ch. 11 Pilbeams > Flashcards

Ch. 11 Pilbeams Flashcards

1
Q

The primary indication of hemodynamic monitoring is:

A

Critically ill patients who demonstrate evidence of compromised cardiovascular function.

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2
Q

Measurements typically include:

A

• systemic arterial pressure (SAP)
• central venous pressure (CVP)
• pulmonary artery pressures (PAP)
• arterial and mixed venous blood gases
• cardiac output

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3
Q

Once obtained these measurements can be used to calculate:

A

• oxygen (O2)
• oxygen delivery (DO2)
• cardiac index (CI)
• vascular resistance
• cardiac work

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4
Q

Measurements can also be used to:

A

Better define abnormalities in cardiopulmonary function and ultimately guide therapeutic interventions

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5
Q

The outputs of the right and left ventricle are ultimately influenced by four main factors:

A

• heart rate
• preload
• contractility
• afterload

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6
Q

Heart range can range from ____to ____ in a normal healthy adult

A

50 to 200

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7
Q

What is preload?

A

The filling pressure of the ventricle at the end of ventricular diastole

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8
Q

What is contractility?

A

The force that the ventricle generates during each cardiac cycle

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9
Q

How can contractility be estimated?

A

The ejection fraction

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10
Q

How is the ejection fraction calculated?

A

As the ratio of SV to the ventricular end diastolic volume

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11
Q

What is afterload?

A

The impedance that the left and right ventricles must overcome to eject blood into the great vessels

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12
Q

Impedance is described as?

A

Systemic and pulmonary vascular resistances

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13
Q

What is SVR?

A

the afterload that the left ventricle must overcome to eject blood into the systemic circulation.

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14
Q

What is PVR?

A

the afterload that the right ventricle must overcome to eject blood into the pulmonary circulation.

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15
Q

Direct measurement of the systemic arterial pressure requires the insertion of a catheter into:

A

A peripheral artery such as:
• radial artery
• brachial artery
• femoral artery

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16
Q

What are central venous lines:

A

Catheters places in the vena cava or right atria

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17
Q

CVP catheters are usually inserted percutaneously into:

A

• a large central vein (internal jugular)
• peripherally through the medial basilic
• lateral cephalic vein

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18
Q

What is the normal CVP?

A

2 to 6 mmHg

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19
Q

What is this image? Fig.11.4

A

Balloon-tipped, flow directed right-sided heart catheter

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20
Q

Label this image: Fig 11.4

A
  1. Ballon inflation valve
  2. Thermistor connector
  3. Thermistor
  4. Proximal lumen
  5. Proximal injection port
  6. Distal lumen
  7. Ballon
  8. Extra injection port
  9. Distal injection port
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21
Q

What does PAOP stand for?

A

Pulmonary artery occlusion pressure

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22
Q

What does PCWP stand for?

A

Pulmonary capillary wedge pressure

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23
Q

Are PAOP and PCWP the same?

A

Yes

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24
Q

What is PAOP?

A

When you inflate the ballon to get a reading

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25
Q

Should you leave the ballon inflated after getting a reading for PAOP?

A

NO!!!!
Could cause an myocardial infarction (MI)

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26
Q

To measure pressure accurately transducer must be:

A

At the same height or level as the catheter tip

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27
Q

PAOP, which reflects preload of the left side of the heart, is a valuable parameter to monitor when performing an…?

A

Optimum PEEP study

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28
Q

If PAOP increases significantly during the study, it could indicate:

A

Overinflation of alveoli

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29
Q

The most common problem associated with CVP catheters is:

A

Pneumothorax

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30
Q

Balloon tipped flow directed catheters are also known as?

A

Swan Ganz Catheter or pulmonary artery catheter

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31
Q

The standard adult catheter is how long and comes in what sizes?

A

110 cm ; sizes 7&8 French

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32
Q

Catheters are marked in _____ cm increments?

A

10

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33
Q

_________ have one lumen that connects to a balloon located near the tip of the catheter and a second lumen that runs the length of the catheter and terminates at a port at the distal end of the catheter.

A

Dual lumen catheters

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34
Q

________have an additional proximal port that terminates approximately 30 cm from the tip of the catheter, or at the level of the right atrium.

A

Triple lumen catheters
This third lumen can be used to measure right atrial pressures or for administrating intravenous medications.

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35
Q

________incorporate a thermistor connector, which contains electrical wires that connect to a thermistor located approximately_______from the tip of the catheter

A

Thermodilution ; 1.5 inches (3cm)

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36
Q

When measuring cardiac output using the thermodilution technique,__________(cold or room temperature) is injected through the catheter’s third (proximal) lumen, which is positioned ________.

A

a bolus of saline or 5% dextrose ; at the level of the right atrium.

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37
Q

What is a normal heart rate?

A

60-100 bpm

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38
Q

Bradycardia is what?

A

Heart rate < 60 bpm

39
Q

What is tachycardia?

A

HR > 100bpm

40
Q

What is the normal range for systolic pressure in adults?

A

90 to 140 mmHg

41
Q

What is the normal range for diastolic pressure for an adult?

A

60-90 mmHg

42
Q

What is the normal mean arterial pressure (MAP)?

A

70-100 mmHg

43
Q

What is systemic hypertension?

A

Systolic arterial pressure greater than 140 mmHg and diastolic pressure greater than 90 mmHg

44
Q

What is systemic hypotension?

A

Systolic pressure is less than 100 mmHg and diastolic pressure is less than 60 mmHg

45
Q

What is pulse pressure?

A

Systolic pressure - diastolic pressure

46
Q

A wide pulse pressure is associated with what?

A

An increased stroke volume and a decreased arterial compliance

47
Q

What is a narrow pulse pressure associated with?

A

Decreased stroke volume and increase arterial compliance

48
Q

What is the range for PAOP?

A

5 to 12 mmHg

49
Q

PAOP greater than 25 mmHg means what?

A

Cardiogenic pulmonary edema from left sided heart failure

50
Q

What is the normal PA systolic pressure for a healthy adult?

A

15 to 35 mmHg

51
Q

What is the normal PA diastolic pressure for an adult?

A

5 to 15 mmHg

52
Q

PAOP plays a major role in the assessment of?

A

Pulmonary hydrostatic pressure in the formation of pulmonary edema

53
Q

PAOP can help distinguish the difference between?

A

Cardiogenic pulmonary edema and non-cardiogenic pulmonary edema

54
Q

PEEP greater than 15 cmH2O can produce what?

A

Erroneously elevated pressure readings

55
Q

What is cardiac output?

A

Volume of blood that is pumped by the heart per minute
Usually expressed in liters per minute or milliliters per minute

56
Q

What is the normal range for cardiac output?

57
Q

How can cardiac output be calculated?

58
Q

What is the formula for cardiac index?

59
Q

What is the formula for stroke index?

60
Q

What is normal cardiac index for an adult?

A

2.5 to 4 L/min/m2

61
Q

What is the normal range for a stroke index?

A

35-55mL/beat/m2

62
Q

What is the Fick principle?

A

Q=VO2/(CaO2-CvO2) x 10

63
Q

Cardiac output involves direct measurements of what?

A

• O2 consumption
• arterial and mixed venous O2 contents

64
Q

What is the normal SvO2?

65
Q

What is the normal CvO2?

A

15vol% (150mL/L of whole blood)

66
Q

Mixed venous oxygen value declines when arterial oxygenation is________?

67
Q

With a reduced cardiac output more time is available for the extraction of_____ from blood delivered to the tissues?

68
Q

Mixed venous oxygen values can be higher than normal in patients with________?

A

Histotoxic hypoxia & in situations with pulmonary shunting

69
Q

DO2 is the product of _____?

A

Cardiac output and arterial oxygen content

70
Q

DO2 represents?

A

The total amount of oxygen that is carried in the blood to the tissues each minute

71
Q

DO2 is approximately?

A

1000mL or about 550 to 650 mL/min/m2

72
Q

DO2 is increased in situations in which_____?

A

Cardiac output or arterial oxygen content is elevated

73
Q

A reduced DO2 indicate a decrease in what?

A

Cardiac output or arterial O2 content

74
Q

DO2 is increased in?

A

Hyperdynamic states (increase cardiac output) such as septic shock

75
Q

What is a shunt?

A

A portion of cardiac output that does not participate in gas exchange with alveolar air (perfusion without ventilation)

76
Q

Shunts are usually identified as:

A

• anatomical shunts
• intrapulmonary shunts
• physiological shunts
latter being the sum of anatomical and intrapulmonary shunts

77
Q

What is the normal range for a shunt?

A

2 to 3% of normal cardiac output

78
Q

What is the equation for physiological shunt?

A

Qs/Qt= (CcO2 - CaO2)/CcO2-CvO2

79
Q

Why do we multiply SVR and PVR by 80?

A

To convert the units from mmHg/L/min to dyne x second x cm^-5

80
Q

SVR will increase as ______ increases?

A

Blood viscosity
(occurs in polycythemia)

81
Q

SVR decreases during?

A

Systemic vasodilation
occurs with moderate hypoxemia or after administration of systemic vasodilators such as nitroglycerin or hydralazine

82
Q

PVR increases during what?

A

• Periods of alveolar hypoxia
• When high intraalveolar pressures are generated such as during positive pressure ventilation

83
Q

What is the normal EF value?

84
Q

During ventricular systole or atrial diastole when the tricuspid valve is CLOSED the pressure measured in the right atrium or vena cava reflects_____

A

Right atrial pressure (RAP)

85
Q

At the end of ventricular diastole and atrial systole when the tricuspid valve is OPEN the pressure measured in the right atrium reflects ________

A

Right ventricular pressure (RVP).

86
Q

What is the standard size and length for pediatric catheters?

A

60 cm in length; size 4 and 5 French

87
Q

What is the rate that flush runs through the catheter?

88
Q

It is important to fully inflate balloon to avoid?

A

• endocardial pulmonary artery damage
• induced ventricular arrhythmias

89
Q

What is the balloon volume for a pediatric catheter?

90
Q

What is the balloon volume for an adult catheter?

91
Q

The balloon should only be inflated for how long when measuring PAOP?

A

15 to 30 seconds
particularly in patients with pulmonary hypertension

92
Q

What is the indicator for left ventricular preload?

A

Left ventricular and diastolic pressure (LVEDP)

93
Q

What is the indicator for contractility?

A

Ejection fraction

94
Q

What is the indicator for afterload?

A

SVR and PVR

Hemodynamics (14 decks)

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