ECCO 1 Flashcards
1
Q
6 P’s of limb ischemia
A
pain, pallor, polar, pulselessness, poikothermia, paralysis, paresthesia
2
Q
complication of connective tissue disorders
A
higher risk of aneurysms
3
Q
2 s/s of AAA
A
N/V, pain in lower back
4
Q
s/s of thoracic aortic aneurysm
A
cough
hoarse
weak voice from pressure against the laryngeal nerve
dysphagia from pressure on the esophagus
5
Q
why is your airway/esophagus affected by a thoracic aortic aneurysm?
A
cough/hoarse/weak voice/dysphagia from pressure against the laryngeal nerve/esophagus
6
Q
most common cause of mortality from ascending aorta/aortic arch aneurysm
A
cardiac tamponade
7
Q
complications of ascending aorta/aortic arch aneurysnm
A
most common cause of mortality = cardiac tamponade
MI
hematoma leads to stroke
8
Q
what happens in abdominal aortic aneurysm
A
retroperitoneal bleed from rupture
renal ischemia due to renal artery involvement
9
Q
organ affected by an abdominal aortic anueyrysm
A
retroperitoneal bleeding from the rupture
renal ischemia due to the renal artery involvement
10
Q
type of aneurysm that can cause spinal ischemia
A
spinal ischemia can occur with descending aorta including spinal arteries
11
Q
complication of descending aorta aneurysm
A
spinal ischemia
12
Q
causes brief neuro dysfunction similar to stroke that can last 1-2hr
A
carotid stenosis has brief neuro dysfunction like stroke but s/s last 1-2hrs
13
Q
carotid stenosis
A
carotid stenosis causes brief neuro dysfunction that looks like a stroke w/ s/s that last 1-2hrs
14
Q
complication s/p carotid stenting
A
bradycardia b/c potential baroreceptor trauma
15
Q
consider if sudden constant abdominal pain
A
AAA
16
Q
s/s of AAA -3
A
sudden constant abdominal pain
low bp
faint pulses
17
Q
EPS
A
study of the heart’s specialized tissue capable of rhythmic impulses
18
Q
single versus dual chamber pacemakers
A
single = either atrium or ventricle
ventricle - A+V
19
Q
what does dual chamber pacing allow
A
allows the clinican to program the AV interval which is similar to the PR interval
20
Q
AV interval (pacemaker setting)
A
AV interval is similar to the PR interval
AV interval is typically set at 0.15 seconds . set it slightly longer than the pt’s AV itnerval to allow for the pt’s ventricle to function on its own. not feasible if pt already has a long PR interval
21
Q
typically AV interval setting for pacemakers
A
0.15 seconds
22
Q
intervention of a ventricular pacemaker is not detecting R waves
A
sensitivity needs to be decrease/lowered to make it more sensitive
23
Q
too high sensitivity of a pacemaker
A
too high sensitivity = pacemaker is not able to sense R waves
24
Q
what happens when you drop sensitivity of a pacemaker
A
dropping pacemaker sensitivity is like dropping a fence to make the “R” waves visible to the pacemaker
25
2 types of pacing
demand versus fixed/asynchronous pacing
26
demand pacing
provider sets the sensitivity so the pacemaker only generates pacing stimuluis if the pt's heart failus to do so after a set amount of time
***lack of intrinsic heart activity triggers the pacemaker to generate an impulse***
27
what triggers a pacemaker operating under demand pacing?
lack of intrinsic heart activity triggers the pacemaker to generate an impusle
28
fixed pacing
aka asynchronous pacing
* sensitivity is set so that the pacemaker cannot sense intrinsic heart activity and delivers output at a set rate regardless of if the pt has intrinsic heart drive
* fixed pacing is risky b/c it can cause vfib if the pacemaker stimulus happens on the T wave
29
complication of fixed pacing
risky b/c it can cause vfib if the pacemaker stimulus happens on the T wave
30
"capture" (pacemaker)
pacing spike after P/QRS
| artierial capture is difficult to see bc the atrialcom[plexes are small
31
set up tempoary pacemaker
1. connect lead wires
2. turn on & set mode
3. set rate (60 -80 bpm or per orders)
4. set output (increase mA) until capture
- if emergency, start at max mA to quickly gain capture)
5. set sensitivity. start at the highest number and decrease until "the fence drops low enough so you can see the intrinsic beats/R wave"
32
rate chosen when you set up a tempoary pacemaker
60-80 bpm
| or per orders
33
set output for tempoary pacemaker
increase output (mA) until capture. if emergency, start at maximum mA and decrease until "the fence drops low enough so you can see the intrinsic beats/R wave"
34
set sensitivity for tempoary pacemaker
start at the highest number and decrease "untilt eh fence drops low enough so youcan see intrinsic beats/R wave"
35
setting sensitivity for tempoary pacemakers
| transcutaneous versus transvenous
```
transcutaneous = 20 -200 mA
transvenous = 0.1 -25 mA
```
36
symptomatic bradycardia
atropine
| pacing
37
placement of the transvenous pacemaker
goes in via the subclavian vein
38
batteries of pacemakers
last 8 -10 years
| might nbot be able to get MRI (check pt's card)
39
3 types of tempoary pacemakers
```
transcutanous = skin pads
transvenous = via subclavian vein
epicardial = electrodes placed during heart surgery
```
40
intervention once you have set up capture for a tempoary pacemaker
once capture is obtained, increase output by 2 mA to p rovide a safety margin so pacing will continue if pt's condition changes
41
pacemaker assessment
need a palpable pulse for each QRS
42
placement of transcutaneous pacing pads
option 1: right sternum between clavicle & left chest wall. negative anterior or 4-5the intercostal space left mid clavicular under breast not below
option 2: right sternum between clavicle & left scapula
43
difference in output setting transcutaneous verus transvenous/epicardial pacing
transcutaneous pacing has higher mA setting b/c paces through the skin
44
how to tell the difference between epicardial pacing wires
(wires directly placed onto the heart during surgery)
| atrial wires are on the right of the sternum; ventricular on the left)
45
important thing to remember about handling epicardial pacemaker wires
atrial = wire on the right of the sternum
ventricular = wire on the left of th sternum
*wear gloves, keep wires separated, insulated
46
things to know when receiving report about transcutaneous/venous/epicardial pacemakers
pacing mode
rate
sensitivity in mV
output in mA
47
unit to express sensitivity (pacing)
mV
48
unit to express output (pacing)
mA
49
decipher pacemaker codes
```
#1: chamber paced
#2: chamber sensed
#3: response to a sensed event
#4: programmable function
```
50
pacemaker code (1st letter)
what chamber is paced?
A = atrial
V= ventricle
D = dual|*pace both to get ventricular kick
51
pacemaker code (2nd letter)
```
What chamber sensed?
O = none. sensing function is not enabled
A = atrial sensing
V= ventricle sensing
D = dual sensing
```
52
pacemaker code (3rd letter)
```
response to sensing
O= none
I= inhibited
T= triggered
D = dual
```
53
sensing (with regards to pacing)
ability to detect the pt's intrinsic atrial/ventricualr activity and respond appropriately
54
ability to detect the pt's intrinsic atrial/ventricular activity and to reponse appropriately
sensing
55
pacemaker code (4th letter)
if "R" rate modulation is present
56
4 pacemaker problems
failure to pace
failure to sense
oversensing
undersensing
57
failure to pace
generator fails to deliver an electrical impulse at the preprogramemd interval
* no pacing spike on the EKG strip &
* intrinsic rate is lower than the programmed pacing rate
58
failure to capture
stimulus is delivered but doesn't result in a depolarization of the paced chamber
* no p wave after atrial spike
* no QRS after ventricular spike
59
pacemaker problem if there is no pacing spike on EKG
failure to pace
60
pacemaker problem if the intrinsic rate is lower than the programmed pacing rate
failure to pace
61
pacemaker problem if there is n p wave after atrial spike
failure to capture
62
pacemaker problem if there is no QRS after ventricular spike
failure to capture
63
what do pacing spikes tell you
pacing spikes indicate pacemaker fired but doesn't ensure capture. to achieve capture, the elctrode must deliver the impusle and the heart must respond
64
undersensing
sends out pacing spikes even though the heart is generating p wave/WRS at adequate intervals
*pacing spikes appear too soon after intrinsic heart events
65
pacing problem if pacing spikes appear too soon after intrinsic heart events
undersensing
66
oversensing
interprets non cardiac acitvity as intrinsic activity. senses waveforms it should not like t waves
*pacing occurs at less than the programmed rate
67
pacing problem if the pacing occurs at less than the programmed rate
oversensing
68
causes of failrue to pace
low battery
loose lead wires
dislodge
programmed rate is lower than order
69
troubleshoot failure to pace -5
```
CXR to check for dislodgement
new batteries
tighten wires
validate rate as ordered
do sensitivity threshold
```
70
causes of failure to capture -6
```
low battery (can't send out signal for depolarization)
output set too low to stimulate
acid-base imbalance
fibrosis at catheter tip
nonresponsive ischemic tissue
hypoxia
high CO2
```
71
troubleshoot failure to capture -3
tighten wires
new batteries
increase mA
72
causes of undersensing
low battery
disconnected/dislodged
sensitivity too high
73
troubleshoot undersensing
replace batteries
tighten wires
validate sensitivity or decrease mV
CXR for lead integirty
74
causes of oversensing -4
low battery
dislodgement
artifact r/t shivering/seizing or other electrical equipmenbt in the room
sensitivity (mV) too low so pacemaker senses other heart activity
75
troubleshooting oversensing -5
replace batteries
tighten wires
unplug/remove unnecessary electrical equipment in the room
validate sensitivity so increae mV so pacemaker is less sensitive
CXR for lead wire integrity
76
hallmarks of undersensing
ventriclar spikes shortly after intrinsic QRS so the pacemaker doesn't recognize heart's own tintrinsic
77
what is happening in failure to capture
spikes fall where they should produce a QRS but dont'
* need more energy to capture
* increase mA setting
78
who should get a ICD
implantable cardioverter defibrillator
* anyone at risk for sudden heart death
- HF with low EF, sustained vtach or congenital filure with ventriclar life-theatening dysrhythmias,
* shock feels liek a chest blow lightheadedness r/t dysrhythmia
79
use of the magnet
magnet over ICD to suspend the antidysthrmic feature
* Pacemaker feture is okay. once the magnet is off, ti can continue to shock
* if tempoarty suspend it, interrogate it to ensure the programming is still correct
80
definition: oversensing
electrical signal inappropriately recognized as native heart activity
81
electrical signal inappropriately recognized as native heart activity
oversensing
82
definition: failure to pace
paced stimulus not generated despite intrinsic rate lower programmed rate
83
paced stimulus not generated despite intrinsic rate lower programmed rate
failrue to pace
84
definition: undersensing
pacing stimulus delivered too after intrinsic event
85
pacing stimulus delivered too soon after intrinsic event
undersensing
86
definition: falure to capture
paced stimulus doesn't result in a palpable pusle or depolarization
87
paced stimulus doesn't result in a palpable pulse or depolarization
failure to capture
88
troubleshooting for all types of pacemaker problems
check battery
wire/cable connection/lead
CXR
89
troubleshooting specifically for failure to pace
validate rate settings. evaluate sensitivity threshold
90
troubleshooting specifically for failure to capture
increase mA,
| Turn patient ont left side
91
troubleshooting specifically for undersensing
validate sensitivity settings
| decrease mV
92
troubleshooting specifically for oversensing
unplug/remove unnecessarily electrical equipment in the room
validate sensitivity setting
adjust mV to a higher number
93
what type of pacing error can be troublshooted by unplugging/removing unnecessary electrical equpment from the room
oversensing
94
main step to consider when treating bradycardia
is there a reversible cause?
| if not, do permanent pacemaker not tempoary
95
mV versus mA
```
mV = sensitivity
mA = output
```
96
intervention if pacemaker spikes occur and aren't followed by a ventricular complex
if pacemaker spike occurs and isn't followed by a ventricular complex, increase mA level until capture is consistently acheived
97
first step to fix failure to pace
check/replace batteries
98
how to identify failrue to pace
HR is lower tha pacemaker set rate and no pacemaker spikes are seen
99
HR is lower than the pacemaker set rate and no pacemaker spikes are seen
failure to pace
100
why should you check pacing thresholds on tempoary pacemakers
b/c you need to know the amount of energy that will trigger depolarization
101
rx to avoid in idioventricualr rhythms
avoid giving lidocaine/antiarrythmics b/c that rhythm is protective
102
mA in an emergency
EEG to help dx electrical activity in the brain
103
intervention if pt is on a continuous EEG to help monitor events
if on a continous EEG, press a button if pt has unusual behavior/motor activity so the neurologist can correlate that behavior/activity with EEEG
104
site for lumbar puncture
3-4 or 4-5 lumbar
| into subarachnoid spacesi
105
site of CSF
subarachnoid space = pia and arachnoid
106
between pia and arachnoid
subarachnoid = site of CSF
107
contraindications to LP
high ICP b/c risk of herniation
| anticoagulants/antiplt b/c hematoma
108
risk of motor/sensory deficits of LP
low risk of motor/sensory deficits post LP b/c the spinal cord ends above the level at which the needle is inserted
109
Lou Gehrig's Disease
ALS = amylotrophic lateral sclerossi
110
s/s of meningitis-4
```
fever
vomit
HA
stiff neck
*inflammation of hte brain/spinal cord
```
111
inflammation of the brain & spinal cord
meningitis
112
between dura and skull
epidural
113
between dura and arachnoid
subdural
114
difference between epidural and subdural
epidural = dura & skull
| subdural =- dura & arachnoid
115
blood filled dilation
aneurysm
116
consider if pt has contrast
contrast is nephrotoxic
117
best test for early detection of brain ischemia
MRI can detect brain ischemia before it is present on CT
118
risk of MRI if pt' has metal/bacemaker
item moves or warms up
119
surgical repair of a blood vessel
angioplasy
120
angeiplasty
surgical repair of a blood vessel
121
Transcranial Dopplers
doppler of hte brain to examine blood circulation
* good for trendign blood flow venocities in subarachnoid hemorrhage and to evaluate for presence of vasospasm
* if arterial passage is narrowed, blood flow veocity increase
122
complication of femoral access sites
increase risk of retroperiotneal bleedign
123
what is diabetes insipitus associate dwith
CNS dysfunction and TBI
124
consider if pt has CNS dysfunction/TBI
diabetes insipitus
125
urine in diabetes insipitus
lots of dilute urine
126
ADH in diabetes insipitus
low ADH b/c peeding out
127
low ADH
diabetes insipitus
128
alterations in ADH
low ADH =diabetes insipitus
| high ADH = SIADH
129
urine in SIADH
low output and concentrated
130
ADH in SIADH
high ADH so holds onto water
131
cerebral salt wasting
ASSOCIATED WITH SUBARACHNOID HEMORRHAGE.
ALTERATIONS IN bnp
LOTS OF WATER ECRETED SO LOW na
132
hallmarks of DI
excessive thirst
diluted urine
consider if TBI or CNS dysfunction
133
potential complication of Guillain-barre
SIADH
134
increased urine osmolarity
high solutes, low water
135
goal of osmotherapy
induce dehydration to decrease water on the brain
136
complication postop pituitiary tumor removal
risk of DI
137
Cerebyx
antielipetic
138
use of transcranial doppler post subarachnoid hemorrhage
measures b. flo & assess for vasospasm
139
complications associated with TI
TBI is associate dwith low Na, hand hypnatremi r/t SIAD
140
noninvasive ICP monitoring
quantitative pupillometery
(trending pupil size/reactivity
*useful when serial measurements are obtained by different providers
141
2 most common sites for ICP monitoring
brain parenchyma
| ventricles
142
ICP catheter that measures CSF
intraventricular catheter
143
why are intraventicular catheters difficlut to place
difficult to place if cerebral edema b/c the ventricles get smaller as edema worsens. becasue as ICP incrases, CSF is shunted out (Monroe Kellie)
144
landmark fo the forament of Monroe
tragus of the ear (tragus isn't the earlobe)
145
use of an intraventricular catheter
transducer and CSF drainage
146
ICP waveforms
* pulsations that originate in teh choroid plexus of the ventricels
* triphasic w/peaks at P1, P2, and P3
147
3 points, peaks, stages
triphasic
148
waveform that has P1, P2, P3
ICP waveform
149
what does decreased intracranila complicance indicate
decreased intracranial complicance indicates the theere is a laock of space within the cranium to accommodate for blood/CSF/brain tissue (Monroe Kelli)
150
positioning if you need to ensure ICP
neutral head poistion
avoid extreme hip flexion b/c that improves jugular venous return b/c decreases intrathoriacif and intrabdominal pressure
HOB 30 degrees
151
effect of fever on the brain
increased cerebral metabolism demands which incrases ICP
152
crainotomy versus crainectomy versus crainoplasty
ectomy = bone flap removed and not replaced
crainotomy = bone flap is replaced
crainoplasty: surgical repair of bone defect post previous operation
153
serum Na in diabetes insipitus
DI = high serum Na
154
leading causes of secondary brain injury
low BP
| hypoxia
155
Train of 4
measures magnitude/type of neuromusclar blockade based on teh ratio of the amplitude of the 4th evoked mechanical repsonse to the 1st one when a total of four 2 Hz electrical ipluses are appleid for 2 second sto a peripheral motor nerve
156
brain in seiure/agniation/fever
increased metabolic demand
157
decreases oxygen suypply to brain
hypooxia
low bp
vasospasm
thrombus
158
calculate CCP
MAP - iCP
159
MAP - ICP
CCP
160
goal of CCP if brain injury
60-70
161
interstitial
fluid filled areas surround the cells of a givne tissue
162
PbtO2
partial pressure of oxygen in brain tissue
| -use b/c ICP and CCP values desn't always represent tissue oxygenation in an injured brain
163
partialpressure of oxygen in brain tissue
PbTO2
164
goal PbTO2
partial pressure of oxygen in brain tissue
| goal = over 20 mm hg
165
rate of CSF drainage if the device is working properly
if a CSF device drain is working properly, CSF will drip into the chamber at a rate determined by the height of hte collection chamber
166
causes of a dampened ICP waveform
air bubbles in teh tube
blocked tubing
stopcock open
brain compartment isn't completely rigid
167
intervention if you notice dampenin go nthe ICP monitor
check for air bubbles
168
intervention of the ICP waveform has P2 higher than P1
there is a decrease in intracranial compliance an the pt might not be able to compensate for intracrainal volume changes
169
most common type of stroke
ischemic (blockage) = 80%
170
aka blood clot
thrombus
| embolis
171
s/s of stroke
```
aphasia
trouble speaking
vision loss
loss of balance/coordinatino
numbness/weakness on one side of the body
```
172
s/s that are less likely to be seen in ischemic stroke
LOC and HA
173
s/s of hemorrhagic stroke
HA b/c blood irritatesthe cerebal tissue
high ICP so LOC
increased ICP b/c blood acting on space occupying lesion
174
type of stroke that is more likely to cause HA
hemorrhagic b/c blood irritates teh brain tissue
175
Broca's area
frontal lobe
| expressive aphasia
176
expressive aphasia
Broca's area
| frontal lobe
177
Wernicke area
parietal/temporal junction
| receptive aphasia
178
receptive aphasia
Wernicke area
| parietal/temporal junction
179
can't speakl or comprehend
aphasia
180
can't recognize own neuro deficits s/p stroke
hemi-inattention. more common in right sided stroke
181
mneumonic for early s/s of stroke
```
BEFAST
balance
eye
face
arms
Speech
time
```
182
imaging for stroke
noncon CT
ischemic doens't show up for 6-8hrs
hemorrhagic stroke imemdiatley shows
183
use of MRI for stroke
ischemia
blood
masses
184
type of MRI sensitive to ischemic stroke
Diffusion-weighted imaging
185
area of ischemia in brain during stroke that can be restored
penumbra
186
penumbra
area of ischemia in a strooke that can be restored
187
rx for strokke
ischemic stroke gets TPA but hemorrhagic doesn't
188
most important question to ask if suspect stroke
last known well
189
stroke questionaire for strokes
National Institute of Health Stroke Scale
190
BP for TPA
under 185/110
| fist line BP control is labatalol
191
first line rx for BP control so you can give TPA
under 185/110
| fist line antiHTN is labatolol
192
if pt is diagnosed with ischemic stroke post CT
if not a candidate for TPA post ichemic stroke, do intrartia fibrolysis if udner 6hrs
193
more likely s/s with ischemic stroke
vision changes and weakness
194
more likely s/s with hemorrhagic shock
HA and LOC
195
stroke more likely if vision changes
ischemic
196
stroke more likely if headache
hemorrhagic
197
stroke more likely if LOC
hemorrhagic
198
what is fibrolytics use for strokes based on
last known well
| hemorrhagic stroke is r/o
199
terminal product of anaerobic glycolysis
lactate
200
what is lactate
terminal product of anaerobic glycolyssi
201
loss of SNS tone
neurogenic shock
202
3 stages of shock
compensatory
progressive
refractory
203
cellular processes in 3rd spacing
increased capillary permeability
| decreased oncotic presusr
204
low aldosterone
Addison's disease
205
Addison's disease
low aldosterone
206
generalized edema
anasarca
207
anasarca
generalized edema
208
exxample of a rx that can cause reflex bradycardia
phenylephrine
209
excessive perspiration
phenylephrine
210
phenylephrine
excessive perspiration
211
effect of histamine on vessels
vasoD
| permeable vessel walls
212
what is serotonin
neurotransmitter that vasoC
213
neurotransmitter that vasoC
serotonin
214
neurotransmitter that vasoD
histamine
215
effect of serotonin on blood vessels
neutrotransmitter that vasoC
216
low serotonin
depression
217
cells that provide heparin
mast cells
218
mast cells
mast cells are resident cells of contnectiv etissue that contains many granules of histamine and heparin
219
labs that go up in anaphylaxis
IgE
eosinophils
mast cells
H&H b/c hemoconcentraion
220
epinephrine concentration for anaphylaxis
1:1K
221
1:on thousand epinephrine
anaphylaxis
222
SIRS
sepsis inflammatory response criterial
223
SOFA
sequential organ function assessment
224
qSOFA
quick sequential organ functioal assessment
225
SIRS
body's systemic inflammatory repnsoe to critical insults
226
SIRS criteria
WBC under 4 or over 12
HR over 90
RR over 20
temperature ouside of 36-38
227
effect of ntric oxide
vasoD
228
programmed cell death
apoptosis
229
glucose level that is ideal in sepsis
keep glucose under 180g
230
bleeding directly into the brain tissue
intracerebral hemorrhage
231
tope cause of hemorrhagic shock
intracerebral hemorrhage
232
type of stroke where seizures are more common
seizures are more common w/hemorrhagic stroke b/c blood irritates the brain
233
s/s more likelly in hemorrhagic shock
N/V
eizures
HA, weakness, LOC
234
what does the CT look like in hemorrhagic shock
blood on CT r/t hemorrhagic stroke appears as hyperdensity (bright white)
235
why is intracranial hemorrhage a medical emergency
b/c hemotoma is a space occupying lession that directly causes cerebral edema
236
what do you need to do in intracranial hemorrhage
needs bp control, intubation to protect airway, EVD placement
237
type of IVF to use in strokes
only use normal saline as IVF in stroke b/c both too high/low glucose worsens shock outcomes
238
why do you need a blue top in strokes
need coagulation profile if intracerebral hemorrhage
| *if on warfainr & INR over 1.4, give prothormbin complex concentrate as a blood clotting factor prepared from FFP
239
interventions for intracerebral hemorrhage
ventricular drain, monitor for changes, surgically evacuate clot
240
accumulation of fluid in the brain ventricles
hydroocephalus
241
accumulatin off fluid in the brain ventricels
hydrocephalyt
242
management of hydrocephalusq
ventricualr shunt
243
intervention if you have a CSF obstruction
ventri cualtr drain
244
NHISS
national institute of health stroke scale
245
interventino if you have a impendign herniation
surgical evacuation
246
why do hemorrhagic stroke pts immediately have increased ICP
b/c compression of hte expanding hematoma
247
ICP nursing treatments-5
```
CPP 60-70
neutral head position
HOB elevated
airway secure
hypertonic IVF
```
248
EVD
exte ventricualr drain
249
"worst headache of life"
subarachnoid hemorrhage"
250
suspect subarachnoid hemorrhage
worst headache of life
251
cause of 50% of subarachnoid HA
aneurysm
252
what happens in subarachnoid hemorrhage
brain bleed when a cerebral aneurysm ruptures a blod fille dsubarachnoid space filled with CSF
253
cause of subarachnoid hemorrhage
```
aneurysm (50%)
AVM
bleeding disorder
trauma
anticoagulation
```
254
calculation for the Fick Method
CO = VO2
divided by
Ca-Cv
255
Fick Method
says that blood flow is proprtional to the difference in concentration of a substance in the blood as it enters and leaves an organ
256
how do you use the Fick Method
determine CO from the blood before it enters and after it leaves the lungs and from the rate at which oxygen is consumed
257
dye dilution method to measure CO
method to measure CO in which a known quanityt and concentraiton of indocyanine or lithium is injected into the blood stream. flow and voluem are calculated by measuring the dye concentraiton at selected time intervals
258
catheter tip that measures temperature
thermistor
259
thermodilution method to measure CO
measruing a change in temperature of the bloodstream after injecting cool saline
260
proper positioning of a PA catheter
PAcatheter is properly placed if proximal port is in teh R atrium and sistal in teh PA
261
PAOP
pulmonary artery occlusion pressure
| *indirect estimate of left atrium pressure
262
central venous pressure
right atrium pressure
* pressure in the thoracic vena cava near the right atrium
* CVP is a major determinant of filling pressure and thus, RV preload
263
what does CO/CI assess
forward flow of blood (blood delivery)
264
what does SV/SI assess
pump performance (contractility)
265
what does CVP/PAOP assess
cardiac fillling pressure and ventiuclar volume before a contraction (preload)
266
what does SVR/PVR assess
resistance to forward flow or both sides of the heart (afterload)
267
aka circulation
hemodynamics
| high versus low blood flow states
268
2 basic definitions of low CO states
hypovolemia
| LV dysfunction
