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Critical Care Test 2 > Hemodynamics > Flashcards

Hemodynamics Flashcards

1
Q

what does the dicrotic notch signify

A

aortic valve closure

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2
Q

Pulsus Paradoxus

A

Inspiration decreases SBP by >10 mmhg

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3
Q

what does pulsus paradoxus indicate?

A
  • Cardiac Tamponade
  • pericarditis
  • lung disease
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4
Q

Pulsus Alternans

A

Regular pattern of pulses amplitude changes that alternate between stronger and weaker beats

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5
Q

Pulsus alternans- what does it indicate

A

End-stage left ventricular heart failure

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6
Q

Pulmonary Artery Line types

A

Swan Ganz, PA line, Right heart catheter

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7
Q

Components of PA Line

-Proximal Injection Port

A

measures CO and CVP

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8
Q

Components of Swan-Ganz

-PA distal Port

A

measures pulmonary artery pressure

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9
Q

Components of Swan Ganz

-balloon inflation port

A

used to inflate the balloon for the flotation during insertion and obtaining PAWP
-use 1-1.5 cc of air

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10
Q

Components of Swan-Ganz

-Thermistor wire connector

A

measures CO

and blood temperature

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11
Q

Compoents of Swan Ganz

  • CCO
  • SvO2 connector
A

measures continuous CCO

-measures SvO2

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12
Q

Indications for PA catheter

A
  • monitor cardiac function (MI, CHF)
  • monitor fluid status
  • Assess the hemodynamic response to fluids, diuretics, vasoactive agents, inotropes
  • manage hemodynamic instability after heart surgery
  • guide shock tx
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13
Q 
PA catheter monitoring meaning:
1- CO /CI
2-CVP
3-PAOP
4-SVR
A

1- how well the heart pump is pumping
2- how full the right side of the heart is
3- how full the left side of the heart is
4- how well the pts arteries can squeeze

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14
Q

NORMAL VALUES

CVP
PPV

A

2-5

7-10

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15
Q

NORMAL VALUES

PAP

A

20-30/ 5-10

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16
Q

NORMAL VALUES

-PAOP

A

5-12

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17
Q

NORMAL VALUES

-SvO2

A

60-75%

*from a central line: 70-80%

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18
Q

NORMAL VALUES

-CO

A

4-6 L

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19
Q

NORMAL VALUES

-Cl

A

2.2-4.0 L

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20
Q

NORMAL VALUES- calculated

-SVR

A

800-1400

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21
Q

NORMAL VALUES- caclulated

-PVR

A

100-250

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22
Q

NORMAL VALUES- calculated

-SV

A

60-70

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23
Q

NORMAL VALUES- Calculated

-SV Index

A
  • 40-50
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24
Q

Locations:

  • Central line
  • PA line
A
  • right atrium

- Pulmonary artery

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25
Q

CVP definition

A

central venous pressure: pressure of blood in the thoracic vena cava, near the right atrium of the heart

  • reflects the amt of blood returning to the heart
  • *RIGHT VENTRICULAR PRELOAD
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26
Q

PAP definition

A

Pulmonary Artery Pressure

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27
Q

PAWP definition

A

Pulmonary Artery Wedge Pressure

-LEFT VENTRICULAR PRELOAD

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28
Q

CO definition

A

volume of blood pumped out by heart in one minute

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29
Q

CI definition

A

cardiac index- cardiac output adjusted for body size

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30
Q

SV definition

A

Stroke volume- volume ejected with each heartbeat

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31
Q

SVI- stroke volume index definition

A

stroke volume adjusted for body size

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32
Q

SVR definition

A

systemic vascular resistance- measures left ventricular resistance (AFTERLOAD) an index of arteriolar compliance or constriction throughout the body

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33
Q

PVR definition

A

Pulmonary vascular resistance- measures left ventricular resistance (AFTERLOAD)

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34
Q

Afterload definitin

A

resistance against which ventricle pumps

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35
Q

Why measure ScVO2

A

Vital signs may be late indicators of compromised oxygen levels,

  • the goal of continuous ScVO2 is t show the relationship between oxygen demand and oxygen consumption
    • GIVES PICTURE OF GLOBAL TISSUE PERFUSION
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36
Q

1- ways that oxygen is delivered

2- ways that oxygen is consumed

A

1- cardiac output, hgb, oxygenation

2-metabolic demand

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37
Q

Reasons metabolic demand/oxygen consumption would be high

A 
Fever
anxiety
pain
shivering
muscle activity

*TREAT WHAT IS CAUSING CONSUMPTION

38
Q

what organ typically fails first when oxygenation is low?

A

the kidneys

-*this is because blood is shunted to vital organs such as the brain and heart

39
Q

how to calculate:

CO

A

CO= SV x HR

40
Q

How to calculate

SVR

A

(BP-CVP)/CO x 80

41
Q

how to calculate:

MAP

A

2(DBP) + SBP / 3

42
Q

How to calculate:

CI

A

CO/BSA

43
Q

How to calculate:

BSA

A

sqr rt: weight (kg) x height(cm)/ 3600

44
Q

how to calculate:

SVI

A

SV/BSA

45
Q

Primary Assessment of Central Lines

A
  • is pt stable?
  • check catheter position
  • is each port being used properly?
  • check connections
  • check tubes for kinks/bubbles
  • is balloon deflated
  • Level and zero the transducer
  • approp. scale for PA catheter
  • contonuous flush is maintained at 300 mmhg
46
Q

Pulmonary artery wedge pressure waveform

A

small waves

* dont leave line in there for >15 seconds!!

47
Q

where do you zero the trasnducer?

A

the phlebostatic axis

-4th intercostal space, level of atria

48
Q

Pt positioning for zeroing a line

A
  • HOB 0-60 degress
  • no lateral positioning
  • phlebostatic axis
49
Q

Square Wave Testing

A

tests the systems accuracy reflecting the pressure and the waveform from the patients

** COUNT OSCILLATIONS after the square wave.
each oscillation should be no more than 1/3 height the previous oscillation

50
Q

Abnormal waveforms
1- overdamped
causes

A
  • air, blood clots in the tubing
  • tubing is too long or kinked
  • connections are loose

*interventions: unkink, loosen, remove clots ect

51
Q

Abnormal waveform:
2- Underdamped
-causes

A

-Air bubble

Interventions* remove bubbles or get new transducer

52
Q

Abnormal waveforms:

-deflated balloons become wedged!

A

notify MD immediatly! urgent intervention

53
Q

PA Ports Uses

- Proximal injection port

A

NO TITRATED MEDS!
this boluses a med into the heart and takes too long

can infuse 482 ml/hr infusions

54
Q

PA port uses

-PA distal port

A

NO MEDS!!

used for mixed venous blood

55
Q

PA Port Uses

-RA port

A

HIGH VOLUME INFUSIONS

56
Q

PA Port uses

-RV port

A

LOW VOLUME INFUSIONS

nothing over 50 cc/hr

57
Q

how long can you wedge for in PA line

A

no more than 15 sec

58
Q

can you leave wedge in permanent wedge position?

A

NO

59
Q

Active or passive deflation of balloon?

A

PASSIVE

60
Q

what can be used in place of wedging ?

A

Pulmonary artery distal pressure

61
Q

how much to inflate wedge balloon

A

no more than 1.5 cc

62
Q

what do you use to inflate the balloon

A

1.5 ml syringe that cones with the balloon

63
Q

Arterial Lines

-functions

A
  • continuous BP readings
  • Serial ABGs
  • less invasive hemodynamic monitoring
64
Q

how to do CO readings

A
  • put pt supine or HOB 30 CO would be lower d/t postural effect of venous return
  • verify computation constant
  • take average of 3 measurements
  • set up tubing for 500 cc D5W bag
  • inject 10 cc smoothly in
65
Q

Swan Complications

A
  • air embolus

- disconnected tubing

66
Q

swan complication

-pulmonary infarction

A

PA rupture of ballon, prolonged inflation of balloon, spontaneous wedging

67
Q

PA complication

-ventricular irritation

A

when catheter migrates back to the RV or is looped thru the ventricle

  • CALL MD
  • can cause Ventricular Tachycardia!
68
Q

PA complication

-risk of Infection

A

an occlusive dressing or biopatch

69
Q

PA complications:

-Thrombosis and embolus

A

air embolus may occur when the balloon ruptures,

clot on end of catheter can cause pumlonary embolus

70
Q

PA complications:

-catheter wedges permanently

A

-EMERGENCY
FLAT LINE PA waveform
can cause pulmonary infarction in only minutes

71
Q

Treating PRELOAD

A

treat until CVP & PAWP normal ranges

-(VOLUME) filling volume of ventricles

72
Q

Treating AFTERLOAD

A

Treat until SVR & PVR normal values

-(SQUEEZE) pressure that ventricles overcome to get blood out of the heart (SVR)

73
Q

Treating Contractility

A

Treat until CO & SV normal values
-(PUMP) strength of myocardial contraction during systole. Frank-starling law: the greater the stretch , the greater the contraction. (SV/CO)

74
Q
  • left ventricular preload

- right ventricular preload

A
  • PAWP

- CVP

75
Q

INCREASED PRELOAD (CVP/PAWP) causes

A
  • adult respiratory distress syndrome
  • Heart failure
  • Pulmonary edema
76
Q

treatment for increased PRELOAD

A
  • Diuretics
  • Mannitol
  • Furosemide
  • Bumetanide
77
Q 
DECREASED PRELOAD (CVP, PAWP)
causes
A
  • hypovolemia

- Septic shock

78
Q

Treatments for Dec. PRELOAD (CVP, PAWP)

A

Volume booster

  • Colloids
  • Crystalloids
  • blood
  • hetastarch
79
Q

INCREASED PVR (pulmonary vascular resist) causes

A

-PVR = (MPAP-PAWP) x 80/CO
pulmonary HTN
-hypoxia
-pulmonary emboli

80
Q

Treatment Increased PVR

-INOTROPES

A

Inotropes (DIGOXIN)- incr. hearts pumping ability

-

81
Q

Tx Increased PVR

-vasodilators

A

Vasodilators (Procardia)- lowers pulmonary blood pressure and incr. heart ability to pump from the right side

82
Q

Tx Increased PVR

-Epoprostenol

A

FLOLAN- dilates pulmonary artery

83
Q

Tx INCR PVR

-Diuretics

A

LASIX/ALDACTONE- removes extra fluid from the tissues and bloodstream, reduces swelling and makes breathing easier

84
Q 
Increased contractility (SV / CO)
causes
A

Any shocks

-increased sympathetic activity

85
Q 
Increased contractility (SV/CO)
-tx
A

Beta blocker, CCB

86
Q 
Decreased CO (SV/CO)
-causes
A 
hypothermia
hypoxemia
low coronary perfusion
MI
cardiomyopathy
87
Q

Decr. Contractility

-tx

A
  • Positive Inotropes
  • (Doputamine
  • Dopamine)
88
Q

Positive Inotropic Agents

A

Increase myocardial contractility

DOPAMINE/DOBUTAMINE

89
Q

Negative Inotropic Agents

A

Decrease myocardial contractility
BB
CCB
(CARDIZEM, VERAPMIL)

90
Q

Positive Chronotropes

A

Increase heart rate

ATROPINE, DOPAMINE, EPI

91
Q

Negative Chronotropes

A

-decrease HR
-BB (metropropol)
-Digoxin
Cardizem

Critical Care Test 2 (6 decks)

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