Exam 1 Lecture 7 Flashcards by Dylan Canada

What is SNS reserve directly correlated to

Cardiac reserve

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What percentage increase can we increase CO In an average human

We can increase it about 400% or 4-fold

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What is it called when the heart grows from frequent and healthy exercise

Physiological hypertrophy
this is usually a good thing

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What is happening at point A

Point A- right after MI hasn’t really compensated yet in real-world compensation happens immediately but not for my class
CO around 2.5-3.0
RAP 2- increased from 0; heart being a poor pump and heart struggles to pump appropriately

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What is happening at point B

Point B
Body will compensate by increasing venous return by constricting heart or SNS tighten up
CO 3.0+
RAP- 5 mmHg
this is still decent not super swell

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What is happening at point C,D

point C, D,
a little improvement
from more volume, from kidneys conserving fluids mostly
increased venous return overall

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What is happening at point E

Point E,
body still retaining fluids
at this point we are stretching heart out too much

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What is happening at point F

Point F
not recoverable
the heart is to stretched out
it is time to cut you losses “DCJC”

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What happens to the LAP if we increase the pressure a shit ton

high LAP will cause pulmonary edema
pulmonary capillaries pressure is definitely lower than systemic; if we have pressure building in LA and excessive pressure, if we add 16mmhg to the 5 currently in there, this prevents all of the fluid reabsorption on venular side of pulmonary capillaries, causing fluid to leak into the lungs
(And yes Shit ton is a real measurement for my class)

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For my class what is the normal pulmonary capillary pressure

Around 5mmHg

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For my class at what value of CO in L/min do we start to see inadequate organ perfusion

Anything less than 5.0 L/min
(So 4.999999999 L/min or less)

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Explain what is happening at Point C and D

Blue line is bad MI
Point C- compensation from system, SNS probably tighten up
Point D- CO 5l/min, venous return increased, moving from point C to D probably from heart recovering some tissues or drugs have helped

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What two vasopressors probably won’t work for this chart

Norepi and EPI won’t help here the body still has plenty floating around

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What does Digoxin do to our filling pressures over time

Decrease overtime with Dig body can ease up on the filling pressure since the drug is making the heart a better pump overall; this allows us to operate at a lower filling pressure

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What is probably the worst tool by itself for monitoring Shock?

Arterial pressure reading is not indicative of level of shock because the system autoregulates it; it is crucial for perfusing tissue, but it is not indicative of CO perfusion

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What is the gold standard of CO measurement

Swan Ganz catheter

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For my shits and giggles, what is the fundamental difference between the red line and black lines in this experiment

Black line were able to survive the experiment
Red lines died

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What does SVO2 stand for

SVO2- saturation venous Hgb with oxygen

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Why is lactate levels important for monitoring shock

Lactate is a byproduct of anaerobic (no oxygen) metabolism. The higher the lactate the lower the perfusion to the tissues

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How does shock impact coagulations levels

coagulation levels- shock has a lot of sludge shitty blood flow and creates clots in blood vessels, coag test not the best test overall

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For my class in regards to the Swan, what does it mean if the saline dilutes out quickly

Normal people call this shooting numbers- injection of cold saline, the faster this saline dilutes out or warms up the higher the CO
die or saline goes through pulmonary artery

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What does the fick equation look at

Looks at gas quantity’s at 2 different side of circulation

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What does VO2 mean?

amount of gas absorbed by lungs per minute, (will have VO2 with a little dot on top of the V means it a unit of time)

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What is the O2 content or arterial and venous blood for a perfectly healthy 30-year-old male

arterial blood- 20ml O2/ dl of arterial blood
vein blood- 15mlO2/dl of venous blood

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In normal systemic tissues how much O2 is exchanged out if your arterial O2 is 20ml)2/dl and your venous O2 is 15mlO2/dl

5mlO2/dl

For my class what is a normal VO2 level

250mlO2/min

Time to bust out the crayons and calculators Using the fick equation- calculate the CO in L/min if our VO2 is 750mlO2/min and our Delta change between arterial and venous circulation remains normal of 5mlO2/dl

150dl/min or 15L/min (750mlO2/min) / (5mlO2/dl)

How many ml are in 1 deciliter

100ml=1deciliter

What percent of the oxygen that the coronaries come in contact with do they extract

They extract about 75% of the oxygen that they receive

A can of soda how many ml's of CO2

Can of soda is 355ml- has 200-250 cc of CO2 in it

Why do we have some retrograde flow at the end of systole on this flowmeter chart

from retrograde blood to Aortic valve as it is closing, also from the cusps on the aortic valve that acts as a bowl

This graph depicts flow rates through the aorta using a flow meter. Why do we have turbulence flow in the aorta, and what is the peak flow in L/min during systole

See a huge spike to 20l/min during systole; this is why we have turbulence right here because high velocity and short time will stagnate blood during diastole

How do we calculate pulse pressure variation

We look at PP max and smallest PP (black arrows) and find the difference between them

If we do a passive leg raise and it reduces pulse pressure variation a lot what does the patient need?

They need volume "he needs some milk..."

During inspiration what happens to left heart filling pressure and left heart preload

Inspiration reduces left heart filling pressure or left heart preload and will drop systolic BP

If our systolic drops more than_______ we need some volume

10mmHg

What is the term defined as pulse pressure variation greater than 10 mmHg increase during normal breathing.

pulsus paradoxus

If we have a low preload, what happens to our pulse pressure variation

Low preload= a lot of variation

Increases in volume does what to our pulse pressure variation

decrease variation

I dont know why we had to talk about this in class but capillary endothelial cells are like real cells because they are real....... but anyway they have nuclei like everyone else

What does toxins and endotoxin release do to our blood vessels

Dilates them out

If the heart sees an increase on volume what will it release in response

Heart will release ANP or ANF when venous volumes are high from blood pooling; it tells kidneys to not hold onto fluids and electrolytes

What functions as the cell's digestive system, serving both to degrade material taken up from outside the cell and to digest obsolete components of the cell itself.

Lysosomes

What does decreased blood flow to the capillaries due to them?

Capillaries with decreased blood flow- cells will destroy and lysosomes will come in and attack the cells and dissolve parts of the cells, will create holes in the capillary endothelial cells and thus create holes in BV and allow colloids to leak out and increase permeability of vessels ( I am looking to reword this question any help is appreciated)

What is one of the requirements for osmosis that Dr. S talked about

for osmosis you must have a semipermeable membrane

What is the best treatment option for capillary dysfunction related to shock

best way to stabilize this from getting worse is to give steroids If you said fix whatever is causing them to be in a shock state you also receive full credit

What does apoptosis mean

Self destruct

What part of the body allows us to have a negative interestital pressure overall

SKIN

What is the normal value of PCap

PCap: 30-10 mmHg

What is the normal value of PIsf

PIsf: -3 mmHg

What is the normal value of PieCap

PieCap: 28 mmHg

What is the nornal value of Pieisf

PieIsf=8mmHg

What is the name for a synthetic colloid we can give in shock

Dextran

Passive leg raise does what exactly

Improves venous return to the heart

What is the other term for lower brainstem

Medulla

In terms of SNS reflexs what does the adrenals dump out

Epi/norepi

What 2 hormones that we discussed in lecture helps our vessels constrict and stay stiff in a short term SNS response besides norepi

Vasopressin and ANG2

Do the kidneys need imput from any other organ system to hold onto fluids

The kidneys dont take no shit from nobody Kidneys will hold onto fluid from RAAS or it can do it by itself with no other involvement

If you lose ______ organ you will be less responsive to shock

Spleen because it is a good source of hgb and RBC so if this is gone you are toast (Heart would also be an answer here.....jk)

The lungs hold onto ______ X as much blood as it normally needs, and in a pinch can be a decent blood reservoir

What is the strongest CV reflex

CNS ischemic response- strongest CV reflex- it tells all BV to constrict as much as they can to maintain perfusion to brain

What are the 3 important nerves to remember in the SNS reflexes

3 important nerves here- glossopharyngeal, herrings, vagus

EXTRA CREDIT LT. Dan's blood pressure would increase how much in mmHg with passive leg raise

Heck i have no idea Happy studying