Exam 1 - Hemodynamics Flashcards
Dicrotic Notch
Represents aortic valve closure on down stroke to right
Why would the dicrotic notch not be visible?
may be dampened
inaccurate
systolic pressure < 50 or 60 mmHg
Placement of Swan Ganz catheter or Pulmonary Artery Catheter
Can be positioned using fluoroscopy
Most often floated into place using waveforms to indicate position
First tracing found during catheter insertion
When catheter is in Right Atrium, normal pressures are
2 - 6 mmHg, reading is close to baseline and looks sawtooth
Second tracing found during catheter insertion
When catheter is in Right Ventricle, normal pressures are
20 - 30 / 0 - 5 mmHg, reading will have large swings in waveforms
Third tracing found during catheter insertion
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
Fourth tracing found during catheter insertion
When catheter is wedged into the Pulmonary Capilary, normal pressures are 4 - 12 mmHg, reading will look sawtooth and be elevated from the baseline
Cardiac Output (CO) System
CO = SV x HR
normal 4-8 L/min
Cardiac Index (CI)
CI = CO / BSA
normal 2-4 L/min
Stroke Volume (SV)
SV = CO/HR
normal 60-130 ml/beat
Systemic Vascular Resistance (SVR)
SVR = MAP - CVP / CO
MAP = Sys + (Dia x 2) / 3
Multiply by 80 to get Dynes
normal 700 - 1600 dynes < 1600
Pulmonary Vascular Resistance (PVR)
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
Mean Arterial Pressure (MAP)
MAP = Sys + (Dia x 2) / 3
normal ~90 mmHg
Target HR
Maximum 220 - age
Ejection Fraction (EF)
SV as %
Afterload
Resistance to ejection
Hard hard to squeeze
Preload
Amount of stretch after diastole and before systole
Central Venous Pressure (CVP)
Right Heart
2 - 6 mmHg
Pulmonary Artery Pressure (PAP)
Lungs
20 - 30 / 6 - 12 mmHg
Pulmonary Capillary Wedge Pressure (PCWP)
Left Heart
4 - 12 mmHg
Right Heart Failure
Cor Pulmonale, Tricuspid Valve Stenosis
Elevated CVP
Low PAP
Lung Disease
Pulmonary Hypertension, ARDS, Pulmonary Embolism
Elevated PAP
Elevated CVP
Left Heart Failure
CHF, Pulmonary Edema, Mitral Valve Stenosis
Elevated PCWP
Low MAP
Low QT
Hypervolemia
All hemodynamic values elevated
Hypovolemia
All hemodynamic values low
Indications for hemodynamic monitoring
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.
Hypovolemia Patient
Decreased - CVP, PCWP, CO, CvO2
Increased - PVP, SVR
Fluid Overload Patient
Decreased - CvO2, SVR, PVR
Increased - CVP, PCWP, CO
(post op patients get 3000 mL in but 700 mL out)
Decreased CVP, PCWP, Urine Output
Check for hypovolemia or decreased SVR
Decreased CVP
Increased PCWP
Could be left heart failure
Increased CVP
Decreased PCWP
Could be right heart failure, COPD, Pulmonary Embolism
Decreased CVP, PCWP
Increased SVR
Natural response to hypvolemia
Heart Failure
Decreased CO, CvO2
Increased CVP, PCWP, PVR, SVR
Late Sepsis
Decreased CO
Increased CVP, PCWP, PVR, SVR
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