Critical Care Flashcards
Cardiac Output
4-8
Cardiac Index
2.5-4
Systemic Vascular Resistance
1100 +/- 300
PCWP
11 +/- 4
CVP
7 +/1 2
Pulmonary artery Pressure
25/10+/-5
Mixed Venous Oxygen Saturation (SvO2)
75 +/- 5
MAP
CO x SVR
How to measure Preload
Wedge Pressure
Preload
related to left ventricular end diastolic pressure
Afterload
Resistance against ventricle contracting (SVR)
Normal O2 delivery to consumption ratio
4:1
Causes of right shift of oxygen-Hgb dissociation curve (O2 unloading)
Increased CO2 (Bohr effect) increased temp Increased ATP production Increased 2,3-DPG production Decreased pH
Hemoptysis after flushing Swan-Ganz catheter
increase PEEP to tamponade pulmonary artery bleed
mainstem intubate non-affected side
Place Fogarty baloon down mainstem on affected side
___ can only be measured by using a Swan-Ganz catheter
Pulmonary vascular resistance
Two determinants of myocardial O2 consumption
ventricular wall tension
HR
Blood w/ lowest venous saturation
coronary sinus blood
Blood w/ highest venous saturation
renal veins
MCC of adrenal insufficiency
withdrawal of exogenous steroids
Acute adrenal insufficiency symptoms
cardiovascular collapse (unresponsive to fluids/pressors) nausea/vomiting abdominal pain decreased glucose increased potassium
DX of adrenal insufficiency
corticotropin stimulation test (ACTH given, cortisol measured)
TX of adrenal insufficiency
Dexamethasone (give empirically, do not have to wait for test results)
Tx of neurogenic shock
Volume first, phenylephrine after resuscitation
Cardiogenic shock tx
(Massive MI, severe CHF)
- dobutamine
- IABP (intra-aortic balloon pump)
Beck’s triad
hypotension
JVD
Muffled heart sounds
1st sign of cardiac tamponade
impaired diastolic filling of right atrium
Only type of shock w/ increased CVP, PCWP
Cardiogenic
Only type of shock w/ increased CO
Septic
Two types of shock w/ increased SVR
Hemorrhagic
Cardiogenic
Early vs late gram negative sepsis
Early: decreased insulin, increased glucose (impaired utilization)
Late: increased insulin, increased glucose (insulin resistance)
First sign of sepsis
Hyperglycemia
Petechia, hypoxia, confusion
fat emboli
Test for fat emboli
sudan red stain
Decreased EtCO2, Hypotension
PE
Tx for air emboli
place patient head down, roll to left, aspirate air out w/ central line or PA catheter
How does intra-aorti balloon pump work
Inflates on T wave (diastole)
Deflates on P wave (systole)
Goal of intra-aortic balloon pump
Improves diastolic coronary perfusion
Mediators of SIRS
IL1
TNF-a
**endotoxin (lipid A) is most potent stimulus –> TNF-a release
Sepsis
SIRS + infection
Septic Shock
Sepsis + hypotension
SIRS
Temp: >38, <36
HR: >90
RR > 20
WBC > 12