CVP, PAC, A line-complications and waveforms

Question 1

In a patient with Raynaud’s-how do you feel about A lines/

Answer 1

I’d rather not do them, but if it must be done a thorough discussion with the patient must be had regarding risks and benefits, and if it must absolutely be done-prefer larger artery

Question 2

Indications for CVP:

Normal CVP

Answer 2

CVP monitoring
Transvenous cardiac pacing
HD
Pressors

Normal CVP: 0-8

Question 3

Possible complications of CVP:

Answer 3

mechanical injury
respiratory compromise due to hematoma or PTX
arrhythmias

Question 4

A wave means: CVP waveform

Answer 4

end diastole; atrial contraction

Question 5

C wave: CVP waveform

Answer 5

Tricuspid contraction

Question 6

V wave: CVP waveform

Answer 6

late systole; systolic filling of the atrium

Question 7

X descent: CVP waveform

Answer 7

RV contraction, pulling tricuspid valve with it

Question 8

Y descent: (CVP waveform)

Answer 8

early diastole; early ventricular filling

Question 9

Loss of a wave means:

Cannon A wave: (CVP waveform)

Answer 9

Loss of a wave: atrial fibrillation/a flutter

Cannon A wave: right ventricular hypertrophy, tricuspid/pulmonary stenosis

Question 10

What does it mean if you have a tall systolic Cv (or just tall V wave) wave and loss of x descent? (CVP waveform)

Answer 10

Tricuspid regurgitation

Question 11

Tricuspid stenosis on CVP waveform:

Answer 11

tall a wave and attenuated y descent

Question 12

Right ventricular ischemia and pericardial constriction on CVP waveform:

Answer 12

Tall a and v waves, steep x and y descent and M or W configuration

Question 13

Cardiac tamponade on CVP waveform:

Answer 13

dominant x descent and attenuated y descent

Question 14

Why would you ever place a PAC?

Normal PCWP

Answer 14

CO/CI
PCWP-normally 6-12
Calculation of mixed venous oxygen saturation
Low EF, left sided valvular disease

Question 15

Complications of PAC:

Answer 15

arterial puncture
arrhythmias 
right bundle branch block 
complete heart block 
v fib
Pulmonary artery rupture

Question 16

PAC waveform mitral regurgitation:

Answer 16

tall regurgitant c-v wave and obliteration of x descent

Question 17

VSD on PAC waveform:

Answer 17

tall anterograde v wave

Question 18

Mitral stenosis on PAC waveform:

Answer 18

tall a wave and attenuation of y descent

Question 19

Myocardial ischemia PAC waveform

Answer 19

tall a and v waves

Question 20

Large A waves on PAC

Answer 20

mitral stenosis, mi, acute CHF

Question 21

Large V waves on PAC:

Answer 21

mitral regurgitation, CHF, CHF (maybe not acute)

Question 22

Things that increase chances of pulmonary artery rupture:

Hallmark of PA rupture

Answer 22

pulmonary HTN, hypothermia, anticoagulation

Hallmark is Hemoptysis

Question 23

How to treat PA rupture:

Answer 23

stabilize cardio/respiratory condition
Intubation can happen with double lumen ETT
PEEP to affected lung
Stop bleeding-reverse AC-unless on bypass, bronchial blocker possibly
as far as removing it-controversial, but i would leave it