Hemodynamic Monitoring

Question 1

Arterial BP shows trending changes in

Answer 1

Volume status
Contractility
SVR
HR
(Contact: VHS)

Question 2

Phlebostatic axis is

Answer 2

Standard reference point on the body used to calibrate the pressure transducer to atmospheric pressure

Question 3

Peak SBP is determined by

Answer 3

1. Volume and velocity of left ventricular ejection
2. PAR : Peripheral arteriolar resistance
3. Dispensability of the arterial system
4. Viscosity of the blood
5. EDV in the arterial system

Question 4

What is the gold standard of BP monitoring

Answer 4

Intra arterial BP monitoring

Question 5

What is normal pulse pressure

Answer 5

40

Question 6

Causes of widened pulse pressure

Answer 6

Systemic HTN
Atherosclerosis
Aortic insufficiency/regurg
Aortic dissection
Hyperthyroidism
Anemia

Question 7

Causes of narrowed pulse pressure

Answer 7

Cardiac tamponade
Hypovolemia
CHF
Cardiogenic shock
Aortic stenosis

Question 8

Anacrotic limb

Answer 8

Corresponds to QRS complex
Reflects contractility
Steep upstroke = strong LV function
More Vertical: regurg, anemia, fever, hyperthyroidism
Slower upstroke: aortic stenosis or ventricular failure

Question 9

What demonstrate systolic BP

Answer 9

Peak on the Anacrotic limb

Question 10

Dicrotic limb

Answer 10

• The downstroke
• Reflects SVR: represents decreased BP and blood flow to the periphery
• steep downstroke w/low dicrotic notch indicates a low SVR and rapid diastolic runoff
• begins at the end of anacrotic limb and goes back to baseline

Question 11

Dicrotic notch

Answer 11

• aortic valve closure w/onset of diastole
• not distinct w/aortic valve regurg/insufficiency
• occurs at the end of T wave
• high notch on the downslope=high SVR
• low SVR will have a notch that is lower

Question 12

What happens to hemodynamic pressure during spontaneous breathing
Inspiration
Expiration

Answer 12

Inspiration: - pleural pressure causes hemodynamic pressures to fall
Expiration: rise in hemodynamic pressures

Question 13

What happens to hemodynamic pressure on ventilator

Answer 13

Inspiration: rises
Expiration: fall

Question 14

When do u read PA pressure

Answer 14

Expiration regardless if pt on a vent or SV,

Point at which intrathoracic pressure equals atmospheric pressure

Question 15

What are the best ways to evaluate volume

Answer 15

Not so good: HR, BP, CVP, UO
GOOD:
TEE
Shock Index SI = HR/SBP.     SI >0.7 = hypovolemia, very sensitive 
TEDoppler, tracer dye analysis, aPPV

Question 16

Flo Trac system and Vigileo monitor

Answer 16

Continous CO, SV, SVV, SVI, SVR through A-line
aPPV is proportional to SV
SVV stroke volume variation >13% = pt needs fluid

Question 17

aPPV what is it

What does the pt need to have

Answer 17

Arterial pulse pressure variations = difference between the max and min pulse pressure after 1 positive pressure ventilation
Pt must be mechanically ventilated