Quiz #3 Hemodynamic Monitoring Flashcards
What is Hemodynamic monitoring?
Is the movement of blood or circulation/perfusion of blood.
Hemodynamic is the movement of Blood pressure
What effect will have Low blood Pressure in cells?
The cells will not recieve the oxygen and nutrients they need to survive.
High Blood Pressure causes:
Strain on the heart and will eventually cause heart failure and increase the risk for Stroke.
What are the three factors that control Blood pressure?
- Heart
- Blood
- vessels
How will the heart react to the administration of Chronotropic Drugs?
It will increase heart rate, ↑ BP, for example atropine
↑ HR = ↑ BP = ↑ CO
What effect will have a decreased heart rate, and what drug can cause it?
↓ HR, will decrease BP
B-Agonist drugs or Beta blockers will decrease HR, like:
- Atenolol
- Propanolol
- Labetalol
Decrease in heart contractility, will have what effect on BP?, and what drug can decrease contractility?
BP will be decreased ↓.
Negative Inotropic drugs will decrease contractility, like:
Calcium Channel Blockers, examples:
- Amlodipine (Norvasc)
- Felodipine
- Isradipine
- Nicardipine
- Nisoldipine (Sular)
- Verapamil (Calan, Verelan)
What drugs can increase heart contractility?
Positive inotropic like:
- dobutamine.
- dopexamine.
- adrenaline.
How the amont of fluid in the system will affects Blood Pressure?
- ↑ in fluid will ↑ BP (hypervolemia)
- ↓ in fluid , will ↓ BP (Hypovolemia)
How we treat excess of fluid in the body system?
Diuretics:
- Lasix (furosemide)
- bumetanide
- Demadex (torsemide)
- Edecrin (ethacrynic acid)
How we treat loss of fluid in the body system?
Decreasing the amount of fliud in the system wil decrease blood pressure, this issue can be fixed by adding fluids or blood products.
The contriction of the blood vessels will affect BP?
Definately, the contriction of blood vessels will ↑ BP. now, dilation of blood vessels will ↓ BP
To decrease vasocontriction, what type of drug do we use?
Vasodilators like:
- Nitroprosside
- Hydralazine
- Milrinone
How we treat vasodilation?
With vasocontriction drugs, like:
- Epinephrine
- phenylephrine
- Dopamine
- Dobotamine
Arterial Pressure can be measured by:
- Sphygmomanometer
- Indwelling arterial cannula
In what artery is usually inserted the Indwelling arterial cannula?
In the Radial Artery
commonly referred as Arterial Line
What is the function of pressure bag?
Prevent outflow of blood into arterial line, is usually kept at 300 mm hg
What does Pressure transducer?
it detects arterial blood pressure and digitizes that signal into a monitor.
What is important about transducer ubication level?
The transducer must remain at the heart level, otherwise bloode pressure may not be accurate.
- If above heart level, arterial pressure will ↓
- If bellow heart level, arterial pressure will ↑
This is called?
3 wat stopcock
Indication for Arterial Blood Pressure Line?
◼ Indicated for continuous pressure measurement of critically ill patients with extremes of blood pressure requiring aggressive resuscitation efforts or titration of potent vasoactive agents
What is the normal Systolic and Diastolic Blood Pressure?
- Systolic: 90 - 140 mm Hg
- Diastolic: 60 - 90 mm Hg
When does start the ejection time on the wave form?
At the beginning of the constraction until the end of the constraction (nicrotic notch)
CVP can be measured by:
- Single lumen catheter
- multiple lumen catheter
all on the SVC
What condiction may elevate CVP?
- Volume overload
- Impaired right ventricular contractile function
- Pulmonary hypertension
- Right ventricular infarction
- Pulmonic stenosis
- Tricuspid valvular disease
- Left-to-right shunts
Pulmonary Artery Catheter are also called?
Swan-ganz catheter
Pulmonary catheter is usually inserted on:
Internal Jugular Vein or Left subclavian vein
How many port does PA catheter have?
4 ports:
- Pressure measurements
- Thermodilution injections
- Cardiac output measurement
- Medication infusions
What pressure does PA measures?
- Right atrium (2 - 6 mm Hg)
- Right ventricle (25/0)
- Pulmonary artery (25/8)
- Left Atrium by PAOP (4 - 12 mm Hg)
Pulmonary Artery Catheter or Pulmonary Artery Oclusion Pressure, meassures what pressure?
It is inserted on the right side of the heart, but it acually meassure the left side of the heart (Left Atrium)
What pressure will affect the improper functioning of the left ventricle (left ventricular failure)?
- PCWP will ↑
- PAP will ↑
- CVP may be affected on severe cases
- CO will be decreased < 4L/min
- Systemic Pressure ↓, < 90/60
(This is because left Ventricle is not able to pump blood to the body system normally any more, producing a back flow, increasing in pressure)
CVP, PAP, PCWP, CO will move in what direction with
- Left Heart Failure
- mitral Valve Stenosis
- CHF
- High PEEP effects
- CVP = Normal
- PAP = ↑
- PCWP = ↑
- CO = ↓
- Systemic Pressure = ↓
Hypervolemia will affects CVP(2-6), PAP(25/8), PCWP(4-12), CO(4-8) in what direction?
Hypervolemia is a condition in which there is too much fluid in the blood. It is also known as fluid overload.
- CVP = ↑
- PAP = ↑
- PCWP = ↑
- CO = ↑
Hypovolemia will affect CVP, PAP, PCWP, CO in what direction?
- CVP = ↓
- PAP = ↓
- PCWP = ↓
- CO = ↓
Lung disordder, Pulmonary embolism, Pulmonary hypertension and Air embolism will affect CVP, PAP, PCWP and CO in what direction?
- CVP = ↑
- PAP = ↑
- PCWP = N/↓
- CO = N
Pulse pressure is done by doing what formula?
Systolic - Diastolic
120 - 80 = 40 pulse
Normal value is 40 mm Hg
Mean arterial pressure (MAP) formula
2(Diastolic) + Systolic)/ 3
Cardiac Output formula
SV x HR = CO
normal value 4 - 8 L/min
What is Systemic Vascular Resistant (SVR)
Is the pressure gradient across the pulmonary circulation divided by CO
SVR = MAP - CVP / CO
normal value < 20 mm Hg/L/min or 1600 dynes/sec/cm-5
- SVR = 14 - 4 / 6*
- SVR = 10 / 6*
SVR = 1.6 mm Hg
Pulmonary Vascular resistance (PVR) formula
PVR = MPAP - PCWP / CO
normal value < 2.5 mm Hg or 200 dynes/sec/ cm -5
What increases PVR
- Hypoxemia
- Pulmonary Hypertension
- Lung disease
CVP catheter is used for:
- Estimate intravascular volume status
- Intravenous access for medication Infusion
- Venous Blood sampling
PA have 3 to 4 ports used for:
- Pressure measurements
- Thermodilution injections ( CO measurements)
- Medication infusions
What pressure does PA catheter measure?
- Right atrium (2-6 mm Hg)
- Right Ventricle (25/0 Systolic/Diastolic)
- Pulminary Artery (25/8 Systolic/Diastolic)
How Left atrial pressure can be determine?
By Pulmonary Artery Occlusion Pressure (PAOP)
