Exam 1 - Hemodynamics

Question 1

Dicrotic Notch

Answer 1

Represents aortic valve closure on down stroke to right

Question 2

Why would the dicrotic notch not be visible?

Answer 2

may be dampened
inaccurate
systolic pressure < 50 or 60 mmHg

Question 3

Placement of Swan Ganz catheter or Pulmonary Artery Catheter

Answer 3

Can be positioned using fluoroscopy

Most often floated into place using waveforms to indicate position

Question 4

First tracing found during catheter insertion

Answer 4

When catheter is in Right Atrium, normal pressures are

2 - 6 mmHg, reading is close to baseline and looks sawtooth

Question 5

Second tracing found during catheter insertion

Answer 5

When catheter is in Right Ventricle, normal pressures are

20 - 30 / 0 - 5 mmHg, reading will have large swings in waveforms

Question 6

Third tracing found during catheter insertion

Answer 6

When catheter is in Pulmonary Artery, normal pressures are 20 - 30 / 6 - 12 mmHg, reading will show waveforms elevated from baseline, should see dicrotic notch

Question 7

Fourth tracing found during catheter insertion

Answer 7

When catheter is wedged into the Pulmonary Capilary, normal pressures are 4 - 12 mmHg, reading will look sawtooth and be elevated from the baseline

Question 8

Cardiac Output (CO)
System

Answer 8

CO = SV x HR

normal 4-8 L/min

Question 9

Cardiac Index (CI)

Answer 9

CI = CO / BSA

normal 2-4 L/min

Question 10

Stroke Volume (SV)

Answer 10

SV = CO/HR

normal 60-130 ml/beat

Question 11

Systemic Vascular Resistance (SVR)

Answer 11

SVR = MAP - CVP / CO
MAP = Sys + (Dia x 2) / 3
Multiply by 80 to get Dynes
normal 700 - 1600 dynes < 1600

Question 12

Pulmonary Vascular Resistance (PVR)

Answer 12

PVR = MPAP - PCWP / CO
MPAP = Sys + (Dia x 2) / 3 (use PAP instead of BP)
Multiply by 80 to get Dynes
normal 20 - 200 dynes < 200

Question 13

Mean Arterial Pressure (MAP)

Answer 13

MAP = Sys + (Dia x 2) / 3

normal ~90 mmHg

Question 14

Target HR

Answer 14

Maximum 220 - age

Question 15

Ejection Fraction (EF)

Answer 15

SV as %

Question 16

Afterload

Answer 16

Resistance to ejection

Hard hard to squeeze

Question 17

Preload

Answer 17

Amount of stretch after diastole and before systole

Question 18

Central Venous Pressure (CVP)

Right Heart

Answer 18

2 - 6 mmHg

Question 19

Pulmonary Artery Pressure (PAP)

Lungs

Answer 19

20 - 30 / 6 - 12 mmHg

Question 20

Pulmonary Capillary Wedge Pressure (PCWP)

Left Heart

Answer 20

4 - 12 mmHg

Question 21

Right Heart Failure

Cor Pulmonale, Tricuspid Valve Stenosis

Answer 21

Elevated CVP

Low PAP

Question 22

Lung Disease

Pulmonary Hypertension, ARDS, Pulmonary Embolism

Answer 22

Elevated PAP

Elevated CVP

Question 23

Left Heart Failure

CHF, Pulmonary Edema, Mitral Valve Stenosis

Answer 23

Elevated PCWP
Low MAP
Low QT

Question 24

Hypervolemia

Answer 24

All hemodynamic values elevated

Question 25

Hypovolemia

Answer 25

All hemodynamic values low

Question 26

Indications for hemodynamic monitoring

Answer 26

Patients with significant hemodynamic instability, frequent arterial blood sampling, severe hypotension (shock), severe hypertension, unstable respiratory failure (ARDS), Patient in need of meds that affect blood pressure (vasodilators or inotropic agents) may benefit from arterial pressure monitoring.

Question 27

Hypovolemia Patient

Answer 27

Decreased - CVP, PCWP, CO, CvO2

Increased - PVP, SVR

Question 28

Fluid Overload Patient

Answer 28

Decreased - CvO2, SVR, PVR
Increased - CVP, PCWP, CO
(post op patients get 3000 mL in but 700 mL out)

Question 29

Decreased CVP, PCWP, Urine Output

Answer 29

Check for hypovolemia or decreased SVR

Question 30

Decreased CVP

Increased PCWP

Answer 30

Could be left heart failure

Question 31

Increased CVP

Decreased PCWP

Answer 31

Could be right heart failure, COPD, Pulmonary Embolism

Question 32

Decreased CVP, PCWP

Increased SVR

Answer 32

Natural response to hypvolemia

Question 33

Heart Failure

Answer 33

Decreased CO, CvO2

Increased CVP, PCWP, PVR, SVR

Question 34

Late Sepsis

Answer 34

Decreased CO

Increased CVP, PCWP, PVR, SVR

Question 35

ok

Answer 35

ok