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Critical Care 1 > Hemodynamics > Flashcards

Hemodynamics Flashcards

1
Q

leveling a-line transducer

A

phelbostatic axis 4th ICS midaxillary

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2
Q

dicrotic notch

A

notch in a-line that represents aortic valve closure

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3
Q

a-line waveform feature that represents aortic valve closure

A

dicrotic notch

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4
Q

how to determine proper pressure in a-line system

A

determine dampening
*no more/less than 3 ossillations before returning to baseline

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5
Q

too little dampening

A

many ossillations. too little dampening that the ossillations won’t die and continue to reverberate

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6
Q

too much pressure in the a-line system

A

overdampening

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7
Q

obstruction in a-line system

A

overdampened

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8
Q

kinded a-line

A

overdampened

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9
Q

air in a-line

A

overdampened

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10
Q

pressure bag overfilled

A

overdampened

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11
Q

Boyle’s law on a-line

A

overdampened

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12
Q

what is overdampening

A

= obstruction in a-line system
too much pressure

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13
Q

causes of overdampened a-line

A

obstruction in aline system
kinked aline
air in system
pressure bag overfilled
Boyle’s law

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14
Q

underdampening

A

a-line system is too dynamic & has too little pressure

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15
Q

a-line if pressure bag isn’t full

A

underdampened -too little pressure

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16
Q

a-line if noncompliant tubing

A

underdampened - too little pressure

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17
Q

what does Swan Ganz measure

A

aka PUlmonary Artery Catheter
*right heart preload/afterload
*left heart preload

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18
Q

insertion site of a Swan Ganz/Pulmonary Artery catheter

A

central line into subclavin vein

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19
Q

what part of the PA catheter is used to measure pressure

A

distal tip

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20
Q

distal tip of the PA catheter

A

measure pressure

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21
Q

how much ml air to measure pressure via PA catheter

A

do not exceed 1.5ml

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22
Q

how to take wedge pressures

A

PA catheter
no more than 1.5ml into distal port
dtake at the end of exhalation
don’t take for longer than 15 sec or 3 breaths

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23
Q

how long to take a wedge pressure

A

no longer than 15 sec or 3 breaths

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24
Q

when do you take a wedge pressure

A

at the end of exhalation

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25
Q

PA catheter PA port

A

for monitoring/lab samples only

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26
Q

PA catheter port for monitoring/lab samples of blood

A

PA port

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27
Q

PA catheter port for infusions/fluids

A

proximal ports

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28
Q

proximal port on PA catheter

A

influsions/fluids

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29
Q

how to transport a pt with a PA catheter

A

deflate the balloon to prevent an inadgertent wedge pressure when it advances
*balloon size increases at altitude b/c Boyle’s Law

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30
Q

progression of Swan-Ganz

A

subclavian
R atrium/ventricle
destination = pulmonary artery
inflate in pulmonary artery to get wedge pressure

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31
Q

site where you get the wedge pressure =

A

pulmonary arteryq

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32
Q

dicrotic notch on the left side of PA catheter waveform

A

RV waveform = tricuspid valve closing

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33
Q

dicrotic notch on the right side of the waveform

A

PA waveform = pulmonic valve closing

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34
Q

measures right heart preload

A

Central venous pressure
2-6 mm hg

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35
Q

Central venous pressure

A

CVP = 2-6mm hg
right heart preload

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36
Q

2-6mm hg

A

Central Venous PRessure
right heart preload

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37
Q

Right ventriclar pressure

A

systolic = 15 - 25mm hg
diastolic = 0-5 mm hg

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38
Q

Pulmonary arty pressure

A

systolic = 15 - 25 mm hg
diastolic = 8-15

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39
Q

systolic pressure of right ventricle

A

15 - 25

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40
Q

diastolic pressure of right ventricle

A

0 - 5

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41
Q

systolic pressure of pulmonary artery

A

15 - 25 mm hg

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42
Q

diastolic pressure of pulmonary artery

A

8-15 mm hg

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43
Q

8-15 mm hg

A

diastolic pressure of pulmonary artery

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44
Q

15 - 25 mm hg

A

systolic pressure of right ventricle & pulmonary artery

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45
Q

PAWP

A

8-12 mm hg

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46
Q

8-12 mm hg

A

PAWP

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47
Q

what does PAWP measure

A

right heart afterload
left heart preload

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48
Q

how to measure left heart preload

A

PAWP

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49
Q

how to measure right heart afterload

A

PAWP

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50
Q

what is normal coronary perfusion pressure

A

50 - 60 mm hg

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51
Q

calculate coronary perfusion prssure

A

DBP - PAWP
= 50 - 60

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52
Q

normal CO

A

4-8L/min

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53
Q

normal cardiac index

A

2.5 - 5 L/min

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54
Q

catheter whip

A

exaggerated waveforms w/elevated systolic pressure and additional peaks (generally only 2 are found) = result of excessive movemnet of the catheter within the artery

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55
Q

how to deal w/catheter whip

A

inflate cuff w/1.5 ml air
cough
lay on right side

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56
Q

troubleshooting PA/Swan Ganz catheter

A

catheter whip
inadvertent wedge

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57
Q

2 cause of inadvertent wewdge

A

balloon migration
ensure the balloon is deflated (Boyle’s law)

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58
Q

treatment for inadvertent wedge

A

you’ll see a PAWP waveform
* deflate the balloon
* cough
* position pt
*withdraw until you see a PA waveform

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59
Q

causes of ireased PA pressure

A

left ventricular failure
liver failure/portal HTN
cor pulmonary/increased pulmomnary vascular resistance
mitral regurg/stenosis

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60
Q

why is MAP decreased in hypovolemia

A

loss of volume

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61
Q

central venous pressure in hypovolemia

A

decreased

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62
Q

SVR in hypovolemia

A

increased

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63
Q

CO in cardiogenic shock

A

decreased

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64
Q

central venous pressure in cardiovenic shock

A

decreased

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65
Q

PCWP

A

pulmonary capillary wedge pressure

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66
Q

indirect estimate of left atrial pressure

A

PCWP = pulmonary capillary wedge pressure

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67
Q

PCWP in hypovolemic shock

A

decreased

68
Q

PCWP in cardiogenic shock

A

increased

69
Q

normal SVR

A

800 - 1200

70
Q

800 - 1200

A

normal SVR

71
Q

normal PVR

A

50 - 250

72
Q

50 - 250

A

PVR

73
Q

SVR in neurogenic shock

A

decreased

74
Q

HR in neurogenic shock

A

decreased

75
Q

shock w/low HR

A

neurogenic

76
Q

skin temp in neurogenic shock

A

cool/moist above
warm/dry below

77
Q

central venous pressure in late septic shock

A

decreased

78
Q

PCWP in late septic shock

A

decreased

79
Q

SVR in late septic shock

A

increased

80
Q

CO in anaphylaxis

A

increased

81
Q

CVP in anaphylasis

A

decreased

82
Q

PCWP in late anaphylaxis

A

decreased

83
Q

SVR in anaphylaxis

A

decreased

84
Q

indications for IABP

A

acute MI w/cardiogenic shock
post CABG
cardiogenic due to HF
-PAWP over 18
-decreased urine output
-SBP under 80

85
Q

PAWP where you may need an IABP

A

PAWP over 18

86
Q

contraindications to IABP -3

A

low plt b/c hemolysis of RBC smash during inflation
aortic insufficiency/disease, severe peripheral vasuclar disease

87
Q

2 effects of IABP

A

increase coronary perfusion
decrease workload of the heart

88
Q

IABP balloon during systole

A

deflated

89
Q

IABP balloon during diastole

A

inflated

90
Q

insertion of IABP

A

inserted into femoral artery directed towards the heart

91
Q

where does the IABP sit

A

in descending aorta
distal to left subclavian artery
above renal artery

92
Q

how do you check IABP placement

A

left radial pusle (left subclavian blockage causes limb ischemia)
adequate UOP b/c renal artery artery decreses UOP
CXR

93
Q

intervention for IABP if power failure

A

manually pump every 3-5 minutes to prevent blood from clotting on the balloon

94
Q

IABP at altitude

A

dont need to purge air b/c self burge

95
Q

transporting IABP

A

bring exter helium tanks

96
Q

how to tell if IABP balloon has ruptured

A

rust/brown flankes in IABP tubing
-flakes are clotted RBC’s inside the tubing

97
Q

rust brown flakes in IABP tubing

A

IABP balloon has ruptured

98
Q

what happens in IABP if you have normal timing

A

decreased workload
increased coronary perfusion

99
Q

early IABP inflation

A

inflation before the aortic valve closes
forces blood back into LV

100
Q

IABP timing error where blood is forced back into the left ventricle

A

early IABP inflation

101
Q

when does early iABP inflation occur

A

inflation before the aortic valve closes
so blood is forced back into the LV

102
Q

effect of early inflation

A

HARMFUL
aortic regurg
decreased CO
increased SVR

103
Q

what does early inflation look like

A

“U” shape

104
Q

when is late inflation of IABP

A

inflation after the aortic valve closes

105
Q

IABP error when inflation occurs after the aortic valve closes

A

late inflation

106
Q

appearence of IABP

A

W

107
Q

W shape of IABP waveform

A

late inflation

108
Q

U shape of IABP waveform

A

early inflation

109
Q

problem of late inflation

A

suboptimal augmentation
decreased coronary perfusion

110
Q

4 shapes of IABP timing errors

A

early inflation = U
late inflation = W
late inflation = cliff shape
late deflation = widened appearence

111
Q

cliff shape of IABP

A

late inflation

112
Q

shape of late inflation

A

cliffe

113
Q

shpe of late deflation

A

widened appearnce

114
Q

widened appearnence of IABP waveform

A

late deflation

115
Q

problem s of early deflation

A

decreaed negative pressure
deflation of balloon beore systole
increased afterload

116
Q

when does the IABP balloon delfate in the timing error of early deflation

A

deflation of balloon before systole

117
Q

worst IABP timing error

A

late deflation

118
Q

what happens in late deflation of IABP

A

inflation of the balloon during systole

119
Q

problems of late inflation IABP

A

inflation of the balloon during systoole
aincreased afterload & workload
harmful/worst tiing erro

120
Q

Impella

A

continuous flow pump
pulls blood from the left ventricle and propels blood into the aorta

121
Q

pulls blood from the left ventricle and propels blood into the aorta

A

Impella = continuous flow pump

122
Q

what does ECMO do

A

Extracorporeal Membrane Oxygenator
forward blood flow
remove CO2/add oxygen

123
Q

use of ECMO

A

good for ARDS
hypoxemic
refractory m. ventilation

124
Q

benefit of ECMO over m. ventilation

A

gas exchange w/o risk of lung injury associated w/ventilator in the presence of catastrophic hypoxemic/hypercarbia

125
Q

SynCardia

A

type of artifical heart. pulsatile device w/ air-driven diaphragm

126
Q

what does failure to capture look like

A

packing spikes are present but not followed by a QRS

127
Q

pacing spikes are present but not followed by QRS

A

failure to capture

128
Q

causes of failure to capture

A

lead dislodged
low output
lead/pacer failure

129
Q

decreased or absent pacemaker function

A

failure to pace

130
Q

failure to pace

A

decreased/absent pacemaker function

131
Q

causes of failure to pacePO 9

A

oversensing
wire fracture
interference
lead displacement

132
Q

undersensing (pacemaker)

A

pacemaker fails to sense native cardiac activity

133
Q

pacemaker fails to sense native cardiac activity

A

undersensing (pacemaker)

134
Q

causes of failure to sense/undersensing

A

poor lead contact
increased stimulation threshold at electrode site
new BBB

135
Q

calculate CI

A

CO/BSA

136
Q

what affects right heart afterload

A

pulmonary arteries (PVR)

137
Q

what affects left heart afterload

A

SVR

138
Q

what measures afterload

A

PVR = right afterload
SVR = left afterload

139
Q

what does PVR measure

A

afterload of right heart

140
Q

normal PVR

A

50 - 250 dynes

141
Q

increased PVR -5

A

over 250
acidosis
hypercapnia
hypoxia
atelectasis
ARDS

142
Q

decreased PVR

A

under 50alkalosis
hypocapnia
vasoD rx

143
Q

effect of pH on PVR

A

incrased PVR = acidosis
decreased PVR = alkalosis

144
Q

effect of CO2 on PVR

A

increased PVR = high Co2
decreased PVR = low COw

145
Q

PVR in ARDS

A

increased over 250

146
Q

PVR in atelectasis

A

increased PVR over250

147
Q

SVR

A

800 -1200 dynres

148
Q

difference in PVR & SVR

A

PRV = afterload of right heart. 50 - 250
SVR = afterload of left heart. 800-1200

149
Q

increased SVR

A

over 1200
hypothermia
hypovolemic shock
decreased CO

150
Q

SVR if hypovolemia/decreased CO

A

increased SVR over 1200

151
Q

SVR if hypothermia

A

increased SVR over 1200

152
Q

decreased SVR

A

over 1200
anaphylaxis
neurogenic shock
spinal shock
septic shock
vasoD rx

153
Q

SVR if vasoD rx

A

decreased SVR below 800

154
Q

SVR if distributive shock (all)

A

decreased SVR below 800

155
Q

SVR in ahaphylaxis

A

decreased under 800

156
Q

dyne

A

measures afterload of left heart
force required to accelerate a mass of one gram a rate of one cm per second squared

157
Q

S3

A

bicuspid/tricuspid close
Kentucky
excessive filling of heart

158
Q

excessive filling of the heart

A

S3 = Kentucky= CHF

159
Q

heart sound in CHF

A

S3 = kentucky= excessive filling of heart

160
Q

common cause of S3

A

CHF. excessive filling of theheart

161
Q

S4

A

blood being forced into a stiff non-compliant ventricle
MI

162
Q

heart sound in MI

A

S4. blood being forced into a stiff non-compliant ventricle

163
Q

S3 versus S4

A

S3 = CHF. excessive filling of hte heart
S4 = MI. blood being forced into a stiff non-compliant ventricle

164
Q

heart sound in hypertrophic cardiomyopathy

A

S4 = blood being forced into a stiff/noncompliant ventricle

165
Q

heart sound heardd in HTN

A

S4 = blood being forced into a stiff noncompliant ventricle

166
Q

heart sound in pulmonary/aortic stenosis

A

S4 = blood being forced into a stiff noncompliant ventericle

Critical Care 1 (14 decks)

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