Hemodynamic Monitoring

Question 1

Mean Arterial Blood Pressure

Answer 1

= Diastolic BP + (Pulse Pressure/3)

Question 2

Systolic Blood Pressure is…

Answer 2

The maximum presssure during ventricular ejection.

Question 3

Diastolic Blood Pressure is…

Answer 3

The lowest pressure in the blood vessels between heartbeats during ventricular filling.

Question 4

T or F: Tamponade reduces the pulse pressure but keeps diastolic pressure constant.

Answer 4

True

Question 5

T or F: Respirations increase systolic and diastolic pressures equally, and the pulse pressure is constant.

Answer 5

False. Respiration reduces systolic and diastolic pressure equally, such that the pulse pressure is constant.

Question 6

Which artery is most frequently used for arterial catheterization?

Answer 6

Radial artery.

Question 7

What test is used to confirm collateral blood flow?

Answer 7

The Allen Test

Question 8

Organ perfusion pressure becomes compromised when MAP decreases below ____ mm Hg and/or cardiac index decraeses below ____ L/min/m2

Answer 8

60 mm Hg and 2.0 L/minute/m2

Question 9

Define central venous pressure.

Answer 9

Back pressure to systemic venous return.

Question 10

Where should the transducer be for CVP monitoring?

Answer 10

The level of the right atrium, approx. 5 cm below the sternal angle.

Question 11

When is it appropriate to measure CVP?

Answer 11

At the end of expiration.

Question 12

A c-wave on the CVP waveform represents?

Answer 12

Bulging of the tricuspid valve into the right atrium which occurs at the onset of systole.

Question 13

What is Cardiac Output?

Answer 13

Measure of the effective blood flow to the tissue.

Question 14

Sphygmomanometric measurements of blood pressure often report slightly higher ______ pressure, and lower _____ pressure that that reported by arterial lines.

Answer 14

Systolic; Diastolic

Question 15

What does it mean if an arterial system is overdamped?

Answer 15

Trapped air bubbles in the tubing are falsely lowering pressure measurements. Underestimation of systolic pressure, diastolic may not be affected.

Question 16

What does it mean if an arterial system is underdamped?

Answer 16

Overestimated systolic pressure, diastolic pressure may be underestimated.;

Question 17

The target MAP for uncontrolled hemorrhage.

Answer 17

40 mm Hg

Question 18

The target MAP for traumatic brain injury.

Answer 18

90 mm Hg

Question 19

The target MAP for other forms of shock

Answer 19

> 65 mm Hg

Question 20

What do high values of CVP indicate?

Answer 20

Larger than normal volume returning to the heart from the systemic circulation.

Question 21

CVP is usually monitored from what veins?

Answer 21

IJ and subclavian

Question 22

What contributes to CVP values?

Answer 22

Central venous blood volume, compliance of the central compartment, tricuspid valve disease, dysrhythmia, level of transducer, Intrathoracic pressure.

Question 23

What do you clean the skin with in prep for a CVL?

Answer 23

Chlorhexidine

Question 24

Where is the sternal angle?

Answer 24

Roughly 5 cm above the center of the right atrium regardless of patient position.

Question 25

What does a pulsation > 4.5 cm vertically above the sternal angle indicate?

Answer 25

A CVP > 9.5 cm H20

Question 26

T or F: Venous pressure is more accurately seen on the right side than the left.

Answer 26

True

Question 27

In ultrasound, if the JV is distended and large than the adjacent common carotid, the CVP is?

Answer 27

> 10 cm H20

Question 28

Normal range of CVP are?

Answer 28

0-10 mm Hg

Question 29

T or F: CVP measures do not correlate with circulating blood volume or changes in blood volume.

Answer 29

True

Question 30

Based on septic shock literature, the target CVP during resuscitation is ?

Answer 30

8-12 mm Hg

Question 31

What is the most important driving force for determining cardiac output?

Answer 31

Perfusion pressure

Question 32

What is considered the ideal indicator of perfusion and oxygen delivery?

Answer 32

Cardiac Output

Question 33

What does Thoracic electrical bioimpedance measure?

Answer 33

Total blood flow within the aorta.

Question 34

Who was TEB first clinically used on?

Answer 34

Astronauts

Question 35

Where do you place the probe during a transcutaneous Doppler ultrasound?

Answer 35

At the sternal notch

Question 36

What is the most important contributor to increasing cardiac output?

Answer 36

Increasing preload by successive fluid challenges.

Question 37

T or F: Positive pressure mechanical ventilation does not alter venous return.

Answer 37

False

Question 38

What postural changes help increase venous return?

Answer 38

Passive leg raises

Question 39

What is preload?

Answer 39

End diastolic volume at the beginning of systole

Question 40

What is afterload?

Answer 40

Ventricular pressure at the end of systole.

Question 41

Where is venous oxygen saturation ideally measured?

Answer 41

The pulmonary artery

Question 42

What does venous oxygen saturation reflect?

Answer 42

The balance between oxygen delivery and oxygen consumption.

Question 43

What does Smvo2 stand for? What does it reflect?

Answer 43

Mixed venous oxygen saturation; The entire body.

Question 44

What does Scvo2 stand for? What does it reflect?

Answer 44

Central venous oxygen saturation; oxygen balance from the upper portion of the body. It does NOT include venous return from the coronary sinus.

Question 45

What are some causes of elevated lactate?

Answer 45

Seizure, DKA, malignancy, thiamine deficiency, malaria, HIV, carbon monoxide, cyanide, and mitochondrial myopathies.