Hemodynamic Monitoring

Question 1

How can you measure tissue oxygenation and perfusion?

Answer 1

Venous oxygen saturation and Blood lactate level indirectly assess tissue oxygenation or perfusion

Question 2

What causes lactate?

Answer 2

Global tissue hypoxia leading to anaerobic metabolism leads to lactate production

Question 3

Types of lactate elevations

Answer 3

Type A: hypoperfusion
Type B: medications (not hypoperfusion)

Question 4

Which type of lactic acid is bad?

Answer 4

Trick question
All lactic acidosis is associated with poor outcomes

Question 5

Causes of type A lactic acid production

Answer 5

Hypoperfusion of tissue
Seizure
DKA
Malignancy
Thiamine deficinecy
Malaria
HIV
Carbo monxide
Cyanide poising
Mitochondrial myopathies

Question 6

Causes of type B lactic acid

Answer 6

Albuterol
Propofol
Metformin
Simvastatin
Lactulose
Antiretrovirals
Niacin
Isoniazid
Linezolid

Question 7

Liver disease and lactic acid

Answer 7

Chronic liver disease decreases lactic acid clearance, so liver players will have higher lactic acid
Liver disease alone wont cause a rise though

Question 8

Lactic acid and the definition of shock

Answer 8

Blood lactate >/= to 2mmol/L

Question 9

Normotensive with hyperlactemia?

Answer 9

Still associated with mortality - investigate it further

Question 10

Lactic clearance in septic shock

Answer 10

Drop of 25% w/in 6hrs in septic shock is associated with increased 60 day survival

Question 11

When lactic acidosis accompanies low flow disease (sepsis) …

Answer 11

Mortality increases 3x - all lactic acidosis is alarming

Question 12

What is optimal CVP?

Answer 12

2-8mmHg

Question 13

Methods of measuring CVP with US?

Answer 13

JVP: measure jugular vein with linear probe, measure point of collapse and sternal angle +5cm=CVP in cmH2O

IVC: through the respiratory cycle
Less than 2cm and more than 50% collapsable with inspiration is CVP <10cmH20