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Critical Care > 🩸Hemodynamics > Flashcards

🩸Hemodynamics Flashcards

1
Q

Cardiac Output

A

SV x HR

indicator of inotropic ability
4-8L/MIN

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2
Q

Cardiac Index

A

CO/Body Surface Area
2.2-4.0L/min

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3
Q

3 Factors of Stroke Volume

A
  1. Preload
  2. Afterload
  3. Contractility
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4
Q

Preload

A

volume indicator
stretch before systole “filling pressure”

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5
Q

Elevated Preload causes (5)

A

Volume overload
Left/Right Ventricular Dysfunction
Valvular stenosis or insufficiency
Cardiac Tamponade

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6
Q

Increased right ventricular vs left ventricular

A

Right = BODY –> hepato-juglar reflux, JVD, edema (increased systemic pressure)
Left = LUNG –> crackles, S3, cough (increased wedge pressure)

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7
Q

Preload reduction –> direct reduction of blood volume

A

Diuretics

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8
Q

Preload reduction –> promote vasodilation

A

Nitrates (Nitroglycerin)

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9
Q

Preload reduction –> patient positioning

A

Semi-fowlers
High - fowlers

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10
Q

Preload reduction is caused by (5):

A

Hypovolemia
Hemorrhage
Third Spacing
Diuresis
Vasodilation

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11
Q

Preload reduction assessment findings:

A

Tachycardia/hypotension
dry, cool skin
dry mucous
poor skin turgor
alt LOC
decreased UOP/vital organ perfusion

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12
Q

Tests for preload

A

CVP R
PCWP L

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13
Q

Treatment for low preload (Non-pharm)

A

Volume administration (Crystalloid, colloid, PRBC)
Modified trendelenburg

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14
Q

Afterload

A

resistance to stretch, FORCE

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15
Q

Afterload critical factor

A

systemic vascular resistence

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16
Q

afterload elevation is caused by (5):

A

vasoconstriction (increased SVR)
alpha 1 agonist –> epi, norepi
catecholamine release
Hypertension
increased aortic impedance (stenosis)

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17
Q

Afterload reduction –> arterial dilation

A

nitroprusside (nipride)

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18
Q

Afterload reduction –> block angio 1 - 2

A

ACE-I/ARBS
(-pril) (-sartan)

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19
Q

Afterload reduction is caused by (4):

A

vasodilation (decreased SVR)
inadequate aortic valve function
inflammatory response
hyperthermia

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20
Q

Pharm to increase afterload

A

Vasopressors
Norepi (levophed)
Phenlyephrine
Dopamine
Vasopressin

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21
Q

Contractility

A

inotropic action THE PUMP
+ increase
- decrease

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22
Q

Pathophys factors influencing contractility (5):

A

calcium and ATP
coronary artery perfusion
o2 supply/demand
heart rate (brady decreases stroke volume; tachy decreases stretch)
BP
valvue competence

23
Q

Low contractility assessment

A

Tachycardia
Cool, pale skin
DUOP
Mental status changes
Poor peripheral circulation

24
Q

Contractility critical values

A

CO/CI, ejection fraction via echo 50-70% norm

25
Q

Positive Inotropic agents

A

increase volume

dobutamine, dopamine, digoxin, milrinone

26
Q

Negative Inotropic agents

A

decrease contractility

beta blockers and calcium channel blockers

27
Q

Inotropic

A

myocardial contraction

28
Q

Chronotropic

A

heart rate

29
Q

Dromotropic

A

rate of electrical conduction in AV node

digoxin, CCB

decrease AV node conduction decrease HR

30
Q

Sympathetic

A

adrenergic response beta receptors

31
Q

Beta 1 receptors

A

in the heart

stim produces + chronotropic/iontropic

32
Q

Beta 2 receptors

A

located in bronchial and vascular smooth muscle

bronchodilation

33
Q

Alpha 1 receptors

A

AFTERLOAD effected here!
vascular smooth muscle
produces vasoconstriction (INCREASED SVR)

34
Q

Parasympathetic

A

cholinergic response
acetylcholine
negative dromotropic and chronotropic effects

35
Q

Vagus nerve

A

innervared PNS with the heart

36
Q

PA cath monitors all hemodynamic parameters aside from:

A

systemic blood pressure

37
Q

Leveling/Zeroing

A

1) Level stopcock of transducer to phlebostatic level
2) Each HOB change
3) Zero balance transducer

https://www.youtube.com/watch?v=vN2_oG9xW50

38
Q

Phlebostatic Axis

A

reference level for placement –> for accuracy

1st line –> first ICS at sternum
2nd line –> mid between anterior/posterior chest (mix axillary)

39
Q

Systolic Art Pressure

A

ejection left ventricular systole
(highest wave)

40
Q

Diastolic Art Pressure

A

end-diastole prior to systolic upstroke

41
Q

Mean Arterial Pressure

A

perfusion pressure

> 60 to adequately perfuse vital organs
70-90 IDEAL

42
Q

Pre-procedure (Art line)

A

Allen’s test

43
Q

Central Venous Pressure

A

measures pressure (VOLUME) in right atrium/vena cava
R ventricular preload

44
Q

Normal CVP

A

less than 8

45
Q

Which CVP port is closest to right atrium?

A

Distal, used for CVP

46
Q

CVP complications (5)

A

CLABSI
Dislodgment
Pneumothorax
Thrombosis
Air embolism (at removal)

47
Q

PA (Swan) Catheter

A

diagnose/evaluate heart disease/shock states

48
Q

PA Distal Lumen

A

open to PA

obtain pressures here

49
Q

PA Proximal lumen

A

open to vena cava/right atrium

deliver bolus here

50
Q

Parameters measured with PA cath?

A

Everything hemodynamic SVR, CO, CVP

51
Q

Cardiac Output - thermodilution method

A

10ml room temp saline

52
Q

CO required clinical practice skills (4)

A

supine 0-60 degrees
zero
level
get measurements

53
Q

Complications PA monitoring

A

Ventricular dysrhythmia
PA rupture or perforation

54
Q

If there is a clot in PA cath what do you do?

A

aspirate before flushing

Critical Care (9 decks)

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