Vascular 10 Q Flashcards
Permanent, localized out pouching or dilation of the vessel wall –> peaking of the arterial wall due to high pressure in the arterial system
Aortic Aneurysm
What test determines length, diameter, and presence of a thrombus for aortic aneurysms?
CT
With AAA, there is dull vague pain in the abdomen, back, and flank. If it is acute and severe what does this indicate?
Ruptured AAA
Your patient states “I can feel my heart beat in my stomach” and you palpate a pulsatile mass. What is this finding consistent with?
AAA
What is a lethal complication of an emergency aortic aneurysm repair?
Intrabdominal hypertension that leads to multi system organ failure
What is the biggest and most modifiable risk factor for aortic aneurysm?
Smoking
An aortic aneurysm can mimic an _ or _
MI or kidney failure
Is anterior or posterior rupture of an aortic aneurysm worse?
Anterior is worse (often death before hospital)
4 signs for an aortic aneurysm rupture?
Turner’s sign, back/flank pain, mass, hypotension
Asymptomatic aortic aneurysm needs surgical repair if it is _ cm in women and _ cm in men
5 cm in women; 5.5 cm in men
What type of shock do you need to worry about in a patient with a ruptured AAA
hypovolemic shock
Seen with aortic aneurysms, what syndrome can occur due to microemboli from an aortic thrombus?
Blue toe syndrome
Are aortic aneurysms more likely in African American men or caucasian men?
Caucasian men
Aneurysm that is uniform in shape
Fusiform
What type of aneurysm presents with deep diffuse chest pain that may extend to the intrascapular area?
Thoracic Aortic Aneurysm
Aneurysm that is pouch like
Saccular
At least one layer is still intact and bound by arterial wall or wall of heart
True aneurysm
After surgical repair of an aneurysm, the HOB should be no more than
45 degrees
Result of a false lumen through which blood flows
Aortic Dissection
The initial goal for treating aortic dissection is to decrease _ and _
HR, BP
If an aneurysm shows growth of _ to _ cm on CT there needs to be intervention
0.5-1 cm
What is the target SBP for aneurysms?
100
Fluid accumulation in the pericardial sac that puts pressure on the heart
Cardiac tamponade
The distal port of the swan Ganz measures __. Normal PA is 15-30/4-12
pulmonary artery pressure and PCWP
SVR (systemic vascular resistance) is the left heart after load. What is the normal?
SVR 800-1200
On the swan Ganz, you must “wedge” to get PAWP. Do not wedge for longer than 10-15 seconds as it can cause capillary rupture. What is the normal PAWP?
PAWP 6-12
The proximal swan ganz cath port measures _ _ pressure. What is the normal?
CVP 3-8
CVP is also the RAP (right atrial pressure–pressure in superior vena cava)
Cardiac index is more specific than CO because it takes BSA into account. What is the normal CI?
2.5-4.5 liters
Pulmonary vascular resistance (PVR) is the right heart after load. It is normally 1/6th of the SVR. What is the PVR normal?
50-250
What are the 3 determinants of stroke volume?
Preload, after load, contractility
normal cardiac output? Formula to calculate?
4-8 L; heart rate x stroke volume
Indications for an a-line include acute HTN, acute hypotension, and frequent ABG’s. What should an a-line never be used for?
Medication administration
_ should be performed before A-line insertion. Always make sure the stop cocks are secure.
Allen test
What are the 5 Ps to remember for monitoring post A-line insertion?
Pain, paralysis, paresthesia, pallor, pulse
Central line that measures pressures inside the heart. Flow is directed with a balloon. Typically has 5 lumens. The distal lumen resides in the pulmonary artery to help monitor PA pressure and o2 saturation.
Swan Ganz Catheter
2 possible complications of a swan ganz catheter
air embolus, pulmonary infarction
Swan Ganz catheter: 1. PA distal lumen is (color) _ 2. Proximal infusion hub is (color) _ 3. Balloon inflation valve is (color) 4. Injectate lumen hub is (color)
- yellow
- clear/white
- red
- Blue
The proximal lumen hub (clear/white) on the swan ganz is for?
Connection of all cardiac infusion drugs
Increased cardiac output indicates a hyperdynamic state such as _ or _
fever or early sepsis
PA numbers will be elevated with _ & _ and decreased with _
elevated: heart failure, cardiac tamponade
Decreased: hypovolemia
Reflects the average CO for the past 3-6 minutes. Measures q30-60 seconds.
Continuous cardiac output
Inject saline into proximal lumen of PA catheter. Thermistor detects differences in blood temp and calculates CO. Uses the average of 3 measurements
Intermittent cardiac output measurement
Decreased SVR Indicates:
A. vasoconstriction
B. Vasodilation
Vasodilation
Determines adequacy of tissue oxygenation. Reflects balance of arterial blood, tissue perfusion, and oxygen consumption
venous oxygen saturation
(SVO2, ScVO2) Svo2 is from PA cath and ScVO2 is from CVP
Normal venous oxygen saturation is (SvO2, ScVO2)
60-80%
Each thin black line on the swan ganz represents _ cm
10
Each thick black line on the swan ganz represents _ cm
50
During hemodynamic monitoring, where should you zero the transducer after insertion and after patient moves?
Phlebostatic axis
CPP is needed to ensure blood flow to the brain. What is the normal and how do you calculate it?
60-100; CPP=MAP-ICP
