Hemodynamic Flashcards by Yuko Porter

Why are Hemodynamics important?

-Decision-making/effects of interventions
-Measurement of pressure,perfusion, oxygenation
-Monitoring fluids stats,preload,afterload,contractility

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Hemodynamics
Goal

adequate tissue perfusion=MAP>65
Oxygenation

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How to caculate MAP?
BP: 102/38

Easy as 123
1S+2D3
102+38x23= 59.3=59

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a) Cardiac out?
b) What is stroke volume?

a) amount of blood pumped by the heart/min
HR x SV
b) Preload
Afterload
Contractility

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Preload
a) what is it?
b) measured by?

a) Filling volume of ventricle @ very end diastole(right and left)
b) CVP
PAWP

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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

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a) cause inc preload patho?
b) Factor elvated valumes?

a) Inc fiuid volume
Venous vasocontstriction
b) CHF
Over hydrartion( IV fluid)
CKD/ESRD
Albumin

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Preload inc
Assessment findings

Too much venous volume(pt is wet)
Crakles
JVD
Hepatomegaly
Peripheral edema

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a) cause dec preload patho?
b) Factor dec valumes?

a) low fluid volume
Venous vasodilation
b) Drug
-nitroglycerin
-lasix,diuretics
Hemorrhage
Dehdration
Burns

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Preload dec
Assessment findings

Not enough venous volume
(pt is dry)
Poor skin turgor
Dry mucous membranes

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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

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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

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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

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Afterload
dec condition?

Sepsis
Medications
-Nipride
-Ace i
-ARB
-CCB

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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