ICU/hemodynamics

Question 1

What is PaO2?

Answer 1

measurement of the partial pressure of oxygen dissolved in blood,

i.e. the amount of oxygen dissolved in the blood; indirectly reflects oxygen saturation of hemoglobin

Question 2

What is FIO2?

Answer 2

Inspired oxygen concentration (expressed as a decimal)

Question 3

What is the normal PaO2/FiO2?

When is it commonly used?

Answer 3

300-500mmHg

ARDS

Question 4

When is ARDS diagnosed in relation to PaO2/FiO2 ratio?

HOw does this help us?

Answer 4

less than 300mmHg

It defines the severity of the ARDS. Can also use to monitor clinic course/improvement

Question 5

What is SaO2?

Answer 5

arterial oxygen saturation or the amount of oxygen bound to hemoglobin

Question 6

Oxyhemoglobin Dissociation Curve

Curve shifts left

1. pH?
2. How it relates to clinical course/surgical timing?
3. pCO2/Hb relationship?
4. Temp?
5. Metabolic demand?
6. O2/Hb relationship?
7. Tissue oxygen delivery?

Right?
6

Answer 6

1. alkaline, pH up
2. Coming out of surgery into the ICU/On ECMO
3. pCO2 decreases
4. Temp decreased (permissive hypothermia)
5. Metabolic demands are down
6. Decrease O2 unloading/Increased affinity for O2 and binding.
7. Decreases
8. acidic, hot person
9. Leaving the ICU/Coming off ECMO
10. pCO2 increases
11. Temp increased
12. Metabolic demands are up
13. Increase O2 unloading and decreased affinity for O2 binding.
14. Increases

Question 7

What is a normal cardiac output?

Answer 7

4-8L/min

Question 8

What is the formula for cardiac output?

Answer 8

HR + stroke volume

Question 9

What is CVP?

Answer 9

central venous pressure

- the pressure in the thoracic vena cava near the right atrium. AKA right atrial pressure.

Question 10

What is cardiac index?

What is normal

Answer 10

CO/BSA

2.5-4.0 L/min/m2

Question 11

MAP

calculation?

Answer 11

Allows us to look at organ perfusion. Normal MAP 70-110

DBP X2 + SBP / 3

Question 12

What is wedge pressure PCWP?

Whats normal?

Answer 12

Pulmonary capillary wedge pressure is an integrated measurement of the compliance of the left side of the heart and the pulmonary circulation.

estimation of left atrial pressure

4-12mmHg

Question 13

Normal ranges for a post-op Cardiac surgery ABG:

1. pH: ?
2. Pco2: ?
3. PO2: ?
4. HCO3- : ?
5. Base Excess: ?
6. Hemoglobin : ?
7. Oxyhemoglobin saturation ?
8. Oxygen content: ?
9. Carboxyhemoglobin saturation: ?

Answer 13

1. 7.35 to 7.45
2. 35-45 mmHg
3. 80 to 100 mmHg
4. 22-27 mEq/L
5. ± 2
6. 10-15 gm/dL (some centers transfusion only if < 8gm/dL)
7. 95% or more
8. more than 16 vol%
9. less than 2%

Question 14

What is your goal for FiO2?

Answer 14

arterial oxygen saturation (SaO2) greater than 90% and a PaO2 greater than 60 mm Hg

Question 15

What does PEEP (Peak (positive) End Expiratory Pressure) do?

Answer 15

5cm H2O Pressure (Physiologic)

1. Increase functional residual capacity
2. Reduce Shunt and Improve V/Q ratio
3. Increase PaO2
4. Decrease FIO2

Question 16

What is the first sign for pneumo post op?

Answer 16

ABGs deteriorate or hemodynamic instability develops for no obvious reason after several hours of stability;

Often 1st sign is sudden increase in peak inspiratory pressure, and vent alarming