Hemodynamics Flashcards

1
Q

If you get systolic pressure variation (with A-line) >10 mmHg with positive pressure ventilation- what does this indicate?

A

It is an indirect measurement of volume status– consistent with hypovolemia

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2
Q

Femoral artery A-line placement

A

Palpate femoral artery (VAN- V closest to P), puncture site below inguinal ligament

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3
Q

Relative contraindications to A-line placement

A

Infection at site, ischemia, raynaud’s, traumatic injury, AV fistula in same extremity, lymphadenectomy, no collateral flow

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4
Q

Radial artery A-line placement positioning

A

Palm up on flat surface, dorsiflex wrist 30-45 degrees supported with towel (avoid hyper dorsiflexion), tape hand to work surface

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5
Q

What are hemodynamics influenced by?

A

blood pressure, blood flow, characteristics of blood- poiseuille’s law- (change in pressure * r^4 * pi/ viscosity of blood * vessel length * 8)

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6
Q

Systolic pressure

A

Max pressure- exerted when heart beats, reflects volume & speed of ejection & compliance of the aorta

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7
Q

Diastolic Pressure

A

Minimum pressure- exerted in between heart beats, reflects vascular resistance & competence of the aortic valve

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8
Q

Mean Arterial Pressure

A

Best indicator of tissue perfusion! Average driving pressure of blood during the cardiac cycle.. can use to calculate CPP (Map-ICP)

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9
Q

Pulse Pressure

A

Systolic - Diastolic, reflects difference in volume ejected from LV into arterial vessels & volume that is already there– function of SV & SVR.. wide PP – increased SV, decreased SVR like in sepsis, narrow PP– decreased SV & increased SVR like in tamponade

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10
Q

Korotkoff sounds

A

Turbulent blood flow will occur when cuff pressure is greater than diastolic & less than systolic (tapping sounds)

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11
Q

How does an automatic blood pressure monitor work?

A

Measures MAP (point of max oscillation amplitude) & calculates systolic & diastolic from formulas that examine the rate of change of pressure pulsations– diastolic most unreliable

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12
Q

Blood pressure cuff sizing

A

Compare length of bladder inside the cuff with the circumference of the patients arm- bladder at least 80% reading should be accurate

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13
Q

Shape of A-line waveform depends on?

A

Force generated by ventricle, speed of ejection, compliance of arterial vessels, rate of forward blood runoff (SVR)

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14
Q

Oscillations after fast flush of A-line

A

2 oscillations occur after fast flush- should be no more than 1/3rd of previous oscillation.. just one flush- have overdampening, “ringing” or repeated- underdampening

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15
Q

A-line complications

A

Ischemia, pseudoaneurysm, hemorrhage, hematoma, embolism, local infection, sepsis, neuropathy, misinterpretation of data

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16
Q

Effect of patient positioning on NIBP

A

NIBP will be higher in the dependent arm (if patient on side- the lower arm) and lower in the nondependent arm

17
Q

CVP monitoring- indications, normal

A

Indication of preload of RV: low with tachycardia and hypotension usually is hypovolemic, high with hypotension indicative of myocardial congestion (MI, tamponade, tension pneumo).. normal is 6-10 mmHg

18
Q

Prior to insertion of PA catheter what needs to be done?

A

Flush all lumens, check integrity of balloon with PASSIVE deflation, prepare transducer, connect lines to appropriate lumens (PA distal, CVP proximal)

19
Q

PA catheter insertion

A

Insert to depth of 20 cm, CVP waveform identified, inflate balloon to carry through RA, RV & into PA)

20
Q

Normal PA pressures

A

Systolic: 15-30/ Diastolic: 5-15 (mmHg)

21
Q

Normal PACWP

22
Q

Complications of CVP & PA lines

A

Infection, pneumo, vessel erosion/perforation, venous air embolism, hemorrhage, rupture of PA, dysrhythmias

23
Q

LiDCO

A

Lithium dilution cardiac output, minimally invasive way of monitoring continuous CO

24
Q

What does EKG monitor

A

Electrical impulses (HR, arrhythmias, ischemia, pacemaker function, electrolytes) NOT contractility/output – think of PEA

25
How does EKG monitoring work
Silver chloride electrodes have conductive gel which decreases electrical resistance of skin, small signal amplified and broadcasted
26
Lead II function
Rhythm detection- inferior portion of heart (RCA)
27
Lead V5 function
Left ventricle (LAD)- placed 5th intercostal space anterior axillary line
28
Lead I function
Circumflex artery monitoring
29
Respiratory impedance monitoring
Measures movement of chest by electrodes- not fool proof
30
Pulse oximetry monitoring
Measurement of arterial hemoglobin oxygenation- measures pulsatile signals across perfused tissue at 2 discrete wavelengths (absorbance of light indicates state of hemoglobin)
31
What are the 2 light emitting diodes in pulse oximetry
Infrared (940 nm wavelength-oxyhemoglobin) Red (660 nm wavelength - reduced hemoglobin)
32
Carboxyhemoglobin appearance
Just like oxyhemoglobin- false high
33
Methemoglobin appearance
Gives saturation of 85% regardless of true oxygenation