Hemodynamic Flashcards
Why are Hemodynamics important?
-Decision-making/effects of interventions
-Measurement of pressure,perfusion, oxygenation
-Monitoring fluids stats,preload,afterload,contractility
Hemodynamics
Goal
adequate tissue perfusion=MAP>65
Oxygenation
How to caculate MAP?
BP: 102/38
Easy as 123
1S+2D3
102+38x23= 59.3=59
a) Cardiac out?
b) What is stroke volume?
a) amount of blood pumped by the heart/min
HR x SV
b) Preload
Afterload
Contractility
Preload
a) what is it?
b) measured by?
a) Filling volume of ventricle @ very end diastole(right and left)
b) CVP
PAWP
a) What CVP?
b) PAWP?
Measures venouse volume
a) Central venous pressure
AKA: RAP right atrium prssure
Coming blood to rihgt=mesure RV preload
b) Pulmonary artery wedge pressure
Coming blood to left= mesure LV preload
a) cause inc preload patho?
b) Factor elvated valumes?
a) Inc fiuid volume
Venous vasocontstriction
b) CHF
Over hydrartion( IV fluid)
CKD/ESRD
Albumin
Preload inc
Assessment findings
Too much venous volume(pt is wet)
Crakles
JVD
Hepatomegaly
Peripheral edema
a) cause dec preload patho?
b) Factor dec valumes?
a) low fluid volume
Venous vasodilation
b) Drug
-nitroglycerin
-lasix,diuretics
Hemorrhage
Dehdration
Burns
Preload dec
Assessment findings
Not enough venous volume
(pt is dry)
Poor skin turgor
Dry mucous membranes
Afterload
a) What is it?
b) What is the main determinant of vascular resistance?
a) RESISTANCE that the ventricle must overcome in order to eject blood from the ventricle
b) lumen size and blood viscosity
Inc or dec afterload
a) when vasodilated?
b) when vasoconstricted?
a) dec afterload = dec SVR
b) inc afterload = inc SVR – makes the heart work harder
a) What SVR?
b) What PVR?
c) goal
a) Systemic vascular resistance
LV afterload
Not volume, mesurement of resistance
b) Pulmonary vascular resistance
RV afterload
c) least work load while still maintaining end oragan tissue perfusion
Afterload
dec condition?
Sepsis
Medications
-Nipride
-Ace i
-ARB
-CCB
Afterload dec
Assessment findings
The body easier time to perfusing
vasodilated
warm extremities
bounding peropheral pulses
If the body vosodilates too much and SVR dec too much?
the heart will not be able to persuse the body
(septic shock)If the bo
Afterload
inc condition?
HTN
Vasopressors
Drugs
-Norepiphrine
Epinephrine
Afterload inc
Assessment findings
The body hearder time to perfusing
vasoconstricted
cool extremities
weak peripheral pulses
Contractility
a) What is it?
b) Enhanced by?
c) Depressed by?
a) ability of how strong the heart squeezes
b) Sympathetic nervous system
Positive inotropes
-digoxin
-dopamine
-dobutamine
b) Acidosis
Hypoxemia, ischemia
B-blocker
What is the best tratment?
why?
He needs volume
He needs inc CVP, inc BP, inc CO
and dec HR and
He is sweating a lots=dyhydration
dehydration
a) Why dec BP?
b) Why inc HR?
a) the amount of fluid in blood vessels — drops dramatically
b) When blood volume is decreased, the heart has to beat faster to try to continue to deliver oxygen to your organs
What is the best tratment?
why?
She doesn’t need volume (CVP 9,SVR 1500)
Her HR is the problem
Heart pump too fast cannot filling right
What is the best tratment?
why?
Septic need volume!=pressure up
O2 also need
Shock=Not enough pursusion
=massive vasodilation
CVR low=stay in the body to not enough pressure to circulate
SVR low=vassele dilated=too weak to push=no resistance
a) SvO2 Monitoring?
b) What’s measure?
c) Must consider?
a) Measurement of oxygen saturation (venous) returning to the right-side heart
b) Accurate assessment of balance between Oxygen delivery & oxygen consumption
c)SaO2, CO
Hgb (delivery) &consumption
a) High Svo2?
b) Low Svo2?
a) receiving more O2 than required
decreased availability of tissue to use O2
(Sepsis)
b) Bleeding
Hypoxemia
Decreased O2 supply
Metabolic demand exceeds O2 supply
Common Types of Noninvasive Monitoring?
BP
MAP (mean arterial pressure)
Jugular venous pressure
ClearSight – helps us monitor (doesn’t definitively tell us that the pt is volume overload)
Passive Leg Raise (PLR)
a) how?
b) What to know from the result?
a) Place pt is 45 degree position & take SBP
Tip pt back so legs are at 45 degree for 60
secs
Put pt back in normal position and take SBP
again see if their SV increases
If the patient is a “responder”, SV will inc by
10%
This means the pt will benefit from receving IV fluid
Invasive
Arterial line
Continuous SBP/DBP & MAP in real time
CVP, ABG analysis
Goes directly into artery
NOT USED FOR IV fluid/drug administration
Assess circulation(cap refill)
Arterial Line
Complications
Infection/Sepsis
–use sterile tech
Embolism
–flush with 0.9% NaCl
Hemorrhage
Damage to Artery
NEVER PUT DRUGS INTO ARTERY
Central venous cath?
Used to assess preload (CVP, SvO2)
Catheter inserted into large vein
Make sure to give the pt a large volume of fluid
Central venous catheter
Complications
Accidental Arterial Insertion(Venous=pulse not palpable)
Pneumothorax(can poke hole in lung)
Arrhythmias(if it touches the side of the ventricle)
Embolism
Infection
Bleeding
Pulmonary artery cath?
Catheter inserted into large vein and threaded into the heart to reach the pulmonary artery
Used to assess pulmonary pressures/left heart preload
Ensuring Reliable (Accurate) Measurements
a) Transducer must be @ level of?
b) Measure with patient in waht position?
c) When pt changes position?
a) Phlebostatic axis
b) consistent (HOB ≤ 30º)
d) Re-zero the scale
