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Critical Care > Hemodynamics > Flashcards

Hemodynamics Flashcards

1
Q

What is an A-line used for? What will you see on the wave form?

A

Continuous BP monitoring & ABG’s.

You will see a dicrotic notch.

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2
Q

What is pulses paradoxus?

A

Diminished amplitude on inspiration in SBP greater than 10. Suggestive of cardiac tamponade, pericarditis or lung disease.

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3
Q

What is Pulsus Alternans?

A

Regular pattern of pulse amplitude changes that alternate between stronger and weaker beats. Suggestive of end-stage left ventricular heart failure.

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4
Q

What is a PA Catheter (Swan Gangze) used for?

A

C.O, CI, & fluid balance
CVP measures right side of heart
PAOP/PAWP measures left side of heart
SVR measures how well your arteries can squeeze

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5
Q

What are complications of PA catheters?

A
  • Air embolus, infection, thrombosis
  • PA rupture causing pulmonary infarction
  • Ventricular irritation when cath migrates back into RV or loops. Can cause VT.
  • Catheter wedges permanently, shows flat PA waveform. Risk of infarct after 3 min.
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6
Q

NORMAL VALUES

  • CVP
  • PAP
  • PAOP
A
  • CVP 2-5mm Hg
  • PAP 20-30/5-10
  • PAOP 5-12
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7
Q

NORMAL VALUES

  • SVO2 (where do we measure it from?)
  • SCVO2 (where do we measure it from?)
  • CI
A
  • SVO2 60-75% (from A-line)
  • SCVO2 70-80% (from central line)
  • CI 2.2-4.0L
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8
Q

NORMAL VALUES

  • SVR
  • PVR
  • SV
  • SV index
A
  • SVR 800-1400
  • PVR 100-250
  • SV 60 - 70mL
  • SV index 40-50
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9
Q

What measures pre-load?

A

CVP & PAOP

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10
Q

What measures after load?

A

SVR

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11
Q

What measures contractility?

A

C.O & SV

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12
Q

What is cardiac index?

A

Cardiac output adjusted for body size

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13
Q

What is SVI?

A

Stroke volume adjusted for body size

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14
Q

What is after load?

A

resistance against which ventricle pumps

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15
Q

What does SVR measure?

A

systemic vascular resistance measures left ventricular after load.

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16
Q

What does PVR measure?

A

Pulmonary vascular resistance against which the right ventricle works.

17
Q

How to calculate CI?

A

CO/BSA

18
Q

What is the proximal injectate port on the PA catheter used for?

A

Infusions up to 492 ml/hr. DO NOT put titrated meds in this port.

19
Q

What is the PA distal port used for?

A

Measuring mixed venous blood. DO NOT infuse meds.

20
Q

What is the RA port used for in the PA catheter?

A

HIGH VOLUME infusion.

21
Q

What is the RV port used for in the PA catheter?

A

LOW VOLUME infusions less than 50ml/hr

22
Q

How long do you wedge for?

A

No longer than 15 seconds

23
Q

How do you deflate the PA wedge?

A

Passive deflation.

24
Q

How many ml of air do you inflate the wedge balloon with?

A

No more than 1.5ml. Only use 1.5ml syringe supplied with catheter.

25
Q

What is square wave testing?

A

Reflects the accuracy of the pressure and waveform. Should use fast flush and observe a square wave.

26
Q

What happens to CO and SVR during cardiogenic shock?

A

CO goes down.

SVR goes up.

27
Q

What happens to CO, central pressures and SVR during hypovolemic shock?

A

CO goes down.
Central pressures go down
SVR goes up.

28
Q

What happens to CO, central pressures and SVR during septic shock?

A

CO goes UP.
Central pressures go down.
SVR goes down.

29
Q

In what order do we tx hemodynamic instability?

A
  1. Preload (CVP & PAWP)
  2. Afterload (SVR, PVR)
  3. Contractility (CO, SV)
30
Q

Your patient is in heart failure and his CVP is 8. What are some possible medications you can administer to decrease preload?

A

Nitro
Nipride
Furosemide
Mantiol

31
Q

Your patient is in hypovolemic shock. What can you administer to increase preload?

A

Administer Colloids, crystalloids, blood, hetastarch, antiarrhythmics.

32
Q

Your patient is in hypovolemic shock. What can you administer to decrease after load (SVR)?

A

Nitro
Alpha Adrenergic Blockers
CCB

33
Q

Your patient is in early septic shock. What can you administer to increase after load (SVR)?

A

Epi, norepi

Dopamine

34
Q

Your patient is hypoxic and a PVR of 350 (100-250). What are possible medications for this patient?

A
  • Inotropic agents (Digoxin) to increase force of contraction.
  • Vasodilators (Procardia, Cardizem). Lowers pulmonary BP and improves pumping ability of R side of heart.
  • Epoprostenol (Flolan). Dilates pulmonary arteries.
  • Diuretics (lasix, aldactone). Removes fluid/reduces swelling, improves ventilation.

Critical Care (4 decks)

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