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apa 1 /sim S. Horvath > CVP and PA-C > Flashcards

CVP and PA-C Flashcards

1
Q

what location of catheter placement is the shortest and straightest path to the heart

A

RIJ

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2
Q

what is the proximal port used for

A

measures RAP and CVP. used for med infusion and to bolus CO measurements

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3
Q

what is the distal port used for

A

measures PA pressure and wedge pressure when balloon is inflated

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4
Q

where is CVP leveled to?

A

4th intercostal space at midaxillary line

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5
Q

when in resp cycle should you measure CVP

A

end-expiration

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6
Q

where should distal tip of central line lie

A

junction of VC and RA

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7
Q

a wave

A

right atrial contraction

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8
Q

c wave

A

right ventricular contraction - bulging of tricuspid into RA.

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9
Q

v wave

A

passive filling of RA

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10
Q

a wave in accordance with the ekg

A

just after p wave

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11
Q

c wave in accordance with ekg

A

just after QRS (ventricular depolarization)

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12
Q

v wave

A

passive filling of RA

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13
Q

v wave in accordance with ekg

A

just after T-wave begins (ventricular repolarization)

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14
Q

x descent

A

RA relaxation

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15
Q

x descent in accordance with ekg

A

ST segment

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16
Q

y descent

A

RA empties thru open tricuspid valve

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17
Q

loss of a waves or only v waves caused by

A

loss of atrial kick. A-fib. ventricular pacing in the setting of asystole.

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18
Q

large v waves

A

high amplitude during ventricular contraction. tricuspid or mitral regurg. acute increase in intravascular volume. ventricular failure. increased PVR and SVR and ventricular septal defect.

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19
Q

giant a waves

A

junctional rhythms

  • complete AV block
  • PVC’s (simultaneous atrial and ventricular contraction)
  • ventricular pacing (asynchronous)
  • tricuspid or mitral stenosis
  • diastolic dysfunction
  • myocardial ischemia
  • ventricular hypertrophy
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20
Q

x descent in the PAWP tracing

A

L atrial relaxation

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21
Q

y descent in the PAWP tracing

A

L atrial emptying associated with the opening of MV. onset of LV diastole.

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22
Q

A wave in PAWP tracing

A

LA systole

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23
Q

C wave in pawp

A

closure of mitral

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24
Q

V wave in pawp

A

filling of LA, as well as upward displacement of the mitral valve during LV systole

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25
Q

normal range CI

A

2.6-4.2

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26
Q

normal CO

A

5-6 L/min

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27
Q

anrep

A

abrupt increase in afterload can cause a modest increase in inotropy

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28
Q

tripe (bowditch) effect)

A

when HR is elevated, Ca doesnt have time to completely leave the cell. This increases amt of Ca sitting on actin and myocin causes a stronger squeeze increases contractility with high HR

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29
Q

SV =

A

EDV - ESV

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30
Q

how does parasympathetic innervation affect inotropy

A

decreases

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31
Q

normal SVR

A

900-1200

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32
Q

normal SVRI

A

1760-2600

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33
Q

normal PVR

A

100-200

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34
Q

normal PVRI

A

225-285

35
Q

RAP

A

1-10

36
Q

RVP

A

15-30 / 0-8

37
Q

PAP

A

15-30 / 5-15

38
Q

PAOP

A

5-15

39
Q

PEEP of 10 usually results in increase of CVP by

A

3

40
Q

causes of high CVP

A

RV failure, cardiac tamponade, constrictive pericarditis

41
Q

what is the usual feature of the PA waveform and what does it represent

A

dicrotic notch, represents aortic valve closure

42
Q

systolic PA pressure represents

A

pressure in the PA as blood is being ejected from the RV

43
Q

diastolic PA pressure represents

A

pressure in the PA as blood moves from the artery into the lungs capillaries

44
Q

the upstroke of the PA tracing is produced by opening of the

A

pulmonic valve

45
Q

the downstroke of the PA tracing contains the

A

dicrotic notch, produced by sudden closure of the pulmonic valve leaflets (the beginning of diastole)

46
Q

west zone 3 pressures

A

pa > pv > PA

47
Q

big A is

A

alveolar

48
Q

zone 2 pressures

A

pa >pA >pv

49
Q

zone 1 pressures

A

PA > pa >Pv

50
Q

when PVR is used clinically it should be viewed as a gross estimate of

A

RV afterload

51
Q

increase in venous pressure ____ preload

A

increases

52
Q

greater compliance leads to ___ filling and ___ preload

A

greater, greater

53
Q

HR and ventricular filling are ____ related

A

inversely

54
Q

hypervolemia, regurgitate of cardiac valves, and heart failure ___ preload

A

increase

55
Q

increase in outflow resistance (pulmonic valve stenosis, pulm htn) ____ ventricular emptying, actually ____ preload

A

impairs, increases

56
Q

when inotropy decreases (ventricular systolic failure), preload

A

increases

57
Q

what is the primary determinant of SVR

A

arteriolar tone

58
Q

SVR is increased by

A

sympathetic activation, hypovolemia, shock

59
Q

SVR is decreased by

A

septic shock, parasympathetic, hypercarbia

60
Q

what does it mean if PVR Is high

A

RV must work harder to move blood forward past the pulmonic valve

61
Q

at low lung volumes, compression of the extra alveolar vessels

A

increases PVR.

62
Q

the lease amt of resistance in the pulm system happens at

A

FRC

63
Q

what does hypoxemia do to PVR

A

increases

64
Q

what does acidemia do to PVR

A

increase

65
Q

what does hypercapnia do to PVR

A

increases

66
Q

what does hypovolemia do to PVR

A

increases

67
Q

what does hyperinflation do to PVR (increased PEEP, increased PIP)

A

increases

68
Q

what does sympathetic stimulation do to PVR

A

increases

69
Q

what does a high HCT do to PVR

A

increases

70
Q

what does strenuous exercise do to PVR

A

decrease

71
Q

what does neo do to PVR

A

increase (same with constrictors)

72
Q

what does nitric oxide to do PVR

A

decrease (same with other dilators)

73
Q

increased PVR is caused by ___ PAO2, ___ PCO2, ___ph

A

decreased, increased, decreased

74
Q

SVO2 is the measurement of the relationship between

A

o2 consumption and O2 delivery

75
Q

fick equation

A

SVO2 = SAO2 - [VO2)/(hb x 1.36 x Q)]

76
Q

a high injectate volume ___ CO

A

under estimates

77
Q

a low injectate volume ___ CO

A

over estimates

78
Q

if injectate is too warm, ___ CO

A

over estimates

79
Q

if partially wedged, ___ CO

A

over estimates

80
Q

if CO is high, injectate moves

A

quickly. low AUC

81
Q

if CO is low , injectate moves

A

slowly. high AUC

82
Q

if injactate is too cold

A

underestimates CO

83
Q

if injectate is too warm

A

overestimates CO

84
Q

unable to predict CO with thermodiluation if

A

r to L cardiac shunt. tricuspid regurg

apa 1 /sim S. Horvath (17 decks)

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