Unit 6 Flashcards
What is hemodynamic monitoring?
A variety of monitoring techniques are designed to provide quantitative information about vascular capacity, blood volume, pump effectiveness, and tissue perfusion.
What is the primary goal of hemodynamic monitoring?
Gain information on cardiac output and perfusion
What is cardiac output?
Amount of blood pumped from the left ventricle each minute
Normal: 3-6L
CO = HR * stroke volume
What is stroke volume?
Amount of blood ejected by left ventricle during contraction
What is end-diastolic volume?
The end of filling the atria and ventricles
What is end-systolic volume?
The end of emptying of atria and ventricles
What is preload?
Degree of myocardial giver STRETCH at the end of diastole - how much blood the atria and ventricles hold
What is afterload?
Pressure or RESISTANCE that the ventricles must overcome to eject blood.
What is contractility?
How hard the hard pushes blood through.
Increases induced by sympathetic stimulation, calcium release, and positive inotropic drugs
Decreases by hypoxia and acidemia
What is central venous pressure measuring?
A catheter that passes through the heart chambers
Used for critically ill patients to monitor CVP which indicates fluid volume status
Normally 2-6
What is cardiac index?
The adjustment for CO requirements is based on body size.
CI = CO/body surface area
Normal 2.8-4.2L
What is the pulmonary artery pressure measuring device?
Also knowsn as Swan-Ganz
Measures right atrial pressure, pulmonary artery pressure, cardiac output, etc.
Confirm placement through chest xray
What is Mixed Venous O2 Saturation?
The amount of O2 not used by tissues when blood returns to the heart
What is intra-arterial blood pressure monitoring?
Goes through the radial artery and is a continual blood pressure monitoring.
Note any bleeding or loose connections - MAKE sure to correct the situation immediately.
What is the qSOFA score?
change in mental status - glasgow coma scale score <15
Respiratory >22
Systolic BP <100
What are risk factors of septic shock?
Immunosuppression
Wounds
Cancer
AIDS
Kidney Disease
Age
Resistant microorganism infections
DM
What is the pathophysiology of septic shock?
The term used to describe circulatory, cellular, and metabolic abnormalities that increase risk of death. After an extreme response to infection leading towards tissue damage and organ failure.
What is s/s of septic shock?
Hypotension
Increased RR
DIC - hypoxia and decreased organ fxn caused by clotting
Warm skin
Low O2
High HR
Low CO
Low urine output
Hyperglycemia
What are diagnosis of septic shock?
SOFA and qSOFA
What are management of septic shock?
1hr Bundle:
Measure lactate lvl (retake if greater than 2)
Obtain blood cultures
Administer antibiotic
Fluid bolus for hypotension or lactate >4
Vasopressors after fluid if hypotension persists to maintain MAP of >65
What is DIC?
Excessive clotting using all the clotting factors which then leads to excessive bleeding.
What is management of DIC?
Replace fluids
Treat underlying causes
Replace coagulation factors
Give Heparin
What are risk factors of DIC?
Sepsis
Trauma
Shock
Cancer
Abruptio placenta
Toxins
Allergic reactions
What is s/s of DIC?
Renal failure
Gangrene
Pulmonary embolism
ARDS
Stroke - severe headache!!
What are the indications and precautions of dobutamine?
I: decreased CO, HF
P: Can cause tachycardia, arrhythmias, and hypotension
What are the indications and precautions of dopamine?
I: used to increase BP and contractility, sometimes bradycardia
P: Tissue necrosis can occur; phentolamine for infiltration
What are the indications and precautions of epinephrine?
I: Cardiac arrest, symptomatic sinus bradycardia, severe hypotension, anaphylaxis
P: Can causes tachycardia, HTN, arrhythmias; increased BP and HR can cause MI and angina
What are the indications and precautions of norepinephrine?
I: Profound hypotension - increases BP through vasoconstriction
P: Can cause bradycardia, HTN; treat with local injection of phentolamine if peripheral infiltration is suspected
What are the indications and precautions of phenylephrine?
I: Increase BP in shock by vasoconstriction
P: Causes tachyarrhythmias and decreased cardiac output
What are the indications and precautions of vasopressin?
I: Potent vasoconstrictor used in shock states; cardiac arrest
P: pressor effect due to vasoconstriction; causes contraction of GI smooth muscle.
What is associated with pump, volume, and squeeze?
Cardiac output
Wedge
Systemic vascular resistance
What is the medication management of septic shock?
Antibiotic
Corticosteroids
Insulin
Heparin
Blood replacement
