Hemodynamics

Question 1

Lactic acid

Answer 1

0.5-1.6 mEq/L

Question 2

MAP

Answer 2

65-105 mmHg

Question 3

Urine output

Answer 3

> 30 mL/hr

Question 4

CVP (Central venous pressure)

Answer 4

2-6 mmHg for non-trauma patient

dependent on whats going on with the patient

Question 5

CO (cardiac output)

Answer 5

4-8

Question 6

CI (Cardiac index)

Answer 6

2.5-4.2

Question 7

SVR (Systemic vascular resistance)

Answer 7

770-1500

Question 8

PVR (Pulmonary vascular resistance)

Answer 8

<250

Question 9

Pulmonary artery systole

Answer 9

15-25

Question 10

Pulmonary artery diastole

Answer 10

8-15

Question 11

PAOP/PAWP

Answer 11

8-12

Question 12

Ejection fraction

Answer 12

55-65%

Question 13

Resting SV

Answer 13

70 mL with a heart rate of 60-130

Question 14

Prelaod

Answer 14

degree of stretch before next contraction (volume coming in)

Question 15

Afterload

Answer 15

Resistance ventricles face to get volume into vessles

Question 16

Contractility

Answer 16

Strength of pump

Question 17

Lactic acid meaning and goal

Answer 17

indicates injury to cell

Goal: decrease by 20% q2h

Question 18

Epinephrine

Answer 18

Vasoconstrictor
Bronchodilator
Tx: anaphylaxis
Overcome 3rd heart block
Restore cardiac function in cardiac arrest
S/E: increase HR and BP, dysrhythmias, angina, necrosis, hyperglycemia

Question 19

Norepinephrine

Answer 19

Vasoconstrictor
First line for hypotension r/t sepsis
Used for hypotension and after cardiac arrest
A/E: mottling leads to necrosis on fingers and toes, tachydysrhythmias, angina, HTN

Question 20

Vasopressin/ADH

Answer 20

Vasoconstrictor
Increases water reabsorption in tubules of kidneys
Concentrated urine
Stimulates contraction of vascular and GI smooth muscle

Question 21

Phenylephrine

Answer 21

Vasoconstrictor - increases BP- IV
Reduces nasal congestion - nasal spray
Not first choice
Used in adjunct to others

Question 22

Dobutamine (inotrope)

Answer 22

Increases contractility 
Continuous IV infusion 
Used in HF because it does not increase the vascular resistance 
A/E: Tachycardia 
Monitor: BP, EKG, I&O

Question 23

Dopamine (inotrope)

Answer 23

Low dose: increased renal perfusion 
Increase myocardial contractility 
Increases CO
A/E: Tachycardia, dysrhythmias, angina, necrosis 
Monitor: urine output

Question 24

Albumin

Answer 24

Blood product
Pulls fluid from interstitial space to the intravascular space
Basically giving yourself a bolus of fluid but from your own body
Idea for patients who are dry intravascularly but have fluid overload signs and symptoms
Use new tubing with every bottle

Question 25

When to give Volume

Answer 25

Positive Passive leg raise Decreased CVP Increased SVR Dehydration

Question 26

When to give Vasopressors (EPI, NorEpi)

Answer 26

Increased CVP Decreased EF Decreased SVR HR manifestations (2nd line)

Question 26

When to give Inotropes

Answer 26

``` Decreased EF HR manifestations (first line) ```

Question 27

A-line waveform

Answer 27

Upstroke: left ventricle contraction Dicrotic Notch: indicates closure of the aortic valve Downstroke: the runoff