Exam 1 Lecture 7 Flashcards
What is SNS reserve directly correlated to
Cardiac reserve
What percentage increase can we increase CO In an average human
We can increase it about 400% or 4-fold
What is it called when the heart grows from frequent and healthy exercise
Physiological hypertrophy
this is usually a good thing
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
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
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
What is happening at point E
Point E,
body still retaining fluids
at this point we are stretching heart out too much
What is happening at point F
Point F
not recoverable
the heart is to stretched out
it is time to cut you losses “DCJC”
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)
For my class what is the normal pulmonary capillary pressure
Around 5mmHg
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)
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
What two vasopressors probably won’t work for this chart
Norepi and EPI won’t help here the body still has plenty floating around
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
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
What is the gold standard of CO measurement
Swan Ganz catheter
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
What does SVO2 stand for
SVO2- saturation venous Hgb with oxygen
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
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
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
What does the fick equation look at
Looks at gas quantity’s at 2 different side of circulation
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)
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
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
2X
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
