Oxygen supply and demand workshop Flashcards
Preload assessment (6)
CVP JVD Breath sounds (crackles indicate fluid overload) Heart sounds (extra S3 or S4) blood loss dry mucous membranes
Normal CVP
2-6
Afterload assessment (6)
dBP Pulse pressure cap refill pulses skin warmth and colour, Hct (blood viscosity)
Contractility assessment
Cardiac history (ie heart failure) Preload (increased preload equals increased contractility except in heart failure) Electrolytes
Stroke volume assessment
look at preload, after load and contractility
Heart rate
Is it increased as a compensatory mechanism?
Ventilation assessment
RR WOB TV (breathing shallow or deep) AE - decreased AE =?atelectasis PCO2
normal PCO2
35-45
Oxygentation assessment
O2 sat PaO2 VQ mismatch Diffusion- AC membrane thickness( crackles or consolidation) Driving pressure- are they on FiO2?
O2 transport
Hgb level
Oxy Hgb disociation curve
O2 demand
pain temp HR RR/WOB Stress
Things that shift the oxy hemoglobin curve to the Right
Increased temp
Increased H+ (low PH)
Increased CO2 (hypoventilation)
Things that shift the oxy hemoglobin curve to the Left
Decreased temp
Decreased H+ (high PH/ aLkalosis)
Decreased CO2 (hyperventilation)
How do we assess overall end organ perfusion
Lactate (norm <2)
ScvO2 (norm 60-80%)
O2ER
Pulse pressure
> 30 is wide
<30 is narrow
EOP CNS
LOC
Restlessness
Agistiation
EOP CVS
chest pain/angina Cardiac enzymes MAP Skin colour/temp Cap refill
EOP RESP
WOB
PO2/PCO2
EOP GI
Liver enzymes
Nausea
Vomiting
Bowel sounds
EOP GU
Kidney enzymes
Urine output
VQ mismatch Dead space (like)
Blood is not reaching the alveoli capillaries for gas exchange decreased cardiac output (like) Clot formation (PE)
VQ mismatch Shunt like
Gas is not reaching the capillaries for gas exchange
atelectasis
Fluid in lungs
Increased afterload means vessels are…
constricted
