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The Movement of blood. This is the measurement of the force (pressure) exerted by the blood as it moves through blood vesseld or heart chanmbers during systole and diastole.
Hemodynaics
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What are the three things that blood pressure is a crucial measurement of?
O2 delivery, perfusion, and integrity of cardiovascular tone.
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What are the 3 factors that control BP?
Heart, Blood, and vessels
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Name three non-invasive hemodynamic monitoring.
Heart rate, blood pressure, and perfusion
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Name three invasive hemodynamic monitoring.
Pulmonary artery catheter, arterial line, central venous pressure.
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The pressure that stretches the ventricular walls at onset of ventricular contraction
Preload
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Forcefulness of the heart muscle contracting under a constant load
Contractility
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The load against which the ventricles must contract
Afterload
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Number of cardiac contractions per minute
HR
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Pressure exerted against the vessel walls during systole and diastole
BP
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Average amount of pressure exerted by the blood in the vessels
MAP
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The venous pressure of the right atrium
CVP
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Pressure in the pulmonary artery
PAP
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Average amount of pressure exerted in the pulmonary artery
Mean PAP
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An indirect indication of left atrial pressure
PCWP
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The amount of blood pumped out the left ventricle and into the systemic circulation
QT
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Amount of blood ejected by the ventricle with every contraction
SV
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The volume of blood pumped by the heart in a unit of time divided by the body surface area
CI
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Pressure against which the heart must push to pump blood to the body
SVR
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Pressure against which the heart must push to pump blood to the lungs
PVR
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Indicates contractility of right ventricular cardiac muscle compared to PVR
RVSWI
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Indicates contractility of left ventricular cardiac muscle compared to SVR
LVSWI
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BP Normal
90-150/60-90 mmHg
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PAP normal
20-35/5-15 mmHg
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Mean PAP normal
10-20 mmHg
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SVR normal
900-1500 Dyne sec/cm -5
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PVR normal
80-250 Dyne sec/cm -5
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Liquids are not compressible. Pressures at any given point within a liquid are transmitted equally. whose principle?
Pascal
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When a closed system is filled with liquid the pressure exerted at one point can be measured accurately at any other point at the
same level
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Hemodyn. is performed to:
evluate intravascular fluid vol., cardia and vascular func., and identify sudden changes in the pt's hemodyn. status
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What kind of PT's would need hemodyn.?
Severe hypo and hypertension, frquent ABG's, and shock/resp. failure
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AKA swan-ganz catheter, flow-directed, balloon topped catheter
Pulmonary artery catheter
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What part of the pulmonary artery catheter: Measure pulmonary artery pressures, Aspirate mixed venous samples, Inject medications, Continuous monitoring of SvO2
Distal lumen
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What is the max inflation vol. of the balloon and the swanz?
1.5cc
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What part of the pulmonary artery catheter: Temperature sensing device, Used during thermodilution QT measurements, Measures core temperature
Thermistor
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This is the most common technique: A bolus of solution of known volume and temp. is injected into the R. atrium, and the resultant change in blood temp. is detected by a thermistor previously placed in the pulmonary artery w/ a catheter. The degree of temp. change between the prox. port and distal tis is a function of this.
Measuring the QT w/ thermaldilution
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The normal cardic output curve looks like?
a rapid smooth upstroke and a gradula downstroke.
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The small area under the cardiac curve indicates?
a high cardiac output.
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A large area under the cardiac curve indicates?
a low cardiac output
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Cardiac output is ________ proportional to the area ubder the cardiac curve.
Inversly
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lies in the right ventricle. Measure CVP. Inject medications. Aspirate blood samples. Inject thermal bolus for thermal dilution CO measurements
Proximal lumen
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What are some indications for pulmonary artery catheter.
Hemodynamically unstable patients, Complex-acute heart disease, Acute-severe pulmonary disease, Shock of all types if severe or prolonged, Severe multisystem trauma or large-area burn injury, Major systems dysfunction undergoing extensive operative procedures
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What are some common uses for a pulmonary artery catheter?
Measure CVP, PAP, and PCWP. Collect mixed venous blood samples, Monitor mixed venous O2 saturation, Measure cardiac output, Provide cardiac pacing
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Where is the Pulmonary artery catheter inserted?
Subclavian or internal jugular vein, superior vena cava, right atrium.
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What is the normal pressure of the right atrium?
0-8 mmHg
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What is the normal pressure of the right ventricle?
20-39 mmHg
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What is the normal pressure for the pulmonary artery?
20-35 mmHg
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What is the normal "wedge" pressure?
5-12 mmHg
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What are some complications of the Pulmonary artery catheter?
Infection, bleeding, pneumothorax, pulmonary artery hemorrhage, pulmonary infraction, air embolism, cardiac arrhythmias
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When doe the pulmonary artery pressure decrease?
Volume of blood ejected by the right ventricle decreases � (�afterload� of the RV). Pulmonary vasculature relaxes or dilates
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When would the pulmonary artery pressure increase?
Pulmonary blood flow increases. Pulmonary vascular resistance increases
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What are some things that would casue the pulmonary vascular resistance to increase?
Constriction, obstruction, and compression
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is also referred to as: Pulmonary artery occlusion pressure (PAOP), Pulmonary artery wedge pressure (PAWP), Left atrial pressure, Left side preload, Left ventricular end-diastolic pressure, Left ventricular filling pressure
PCWP
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What can be used to estimate PCWP is some situations
PAP diastolic
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A comparison of PCWP and PAP can be used to differentiate between
cardiac and non-cardiac pulmonary edema. Increased PCWP and PAP = cardiac. Normal PCWP and Increased PAP = Non-cardiac
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What Causes Pulmonary Capillary Wedge Pressure to Decrease?
Right heart failure, Cor pulmonale, Pulmonary embolism, Pulmonary hypertension, Air embolism, Hypovolemia
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What Causes Pulmonary Capillary Wedge Pressure to Increase?
left heart failure, mitral valve stenosis, CHF/ pulmonary edema, high PEEP effects, hypervolemia
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What are the two common uses of the arterial catheter?
Measureing systemic artery pressure and collect ABG samples
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Where the inserion site of the arterial catheter?
Radial (can be placed brachial, femoral, dorsalis pedis, umbilical neonates)
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Add picture 38 and 39
should have done it by now
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Sytolic (contraction) range
90-150 mmHg
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Diastolic (relaxation) range
60-90 mmHg
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normal Mean arterial pressure range
79-110 mmHg
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Causes of Decreased Arterial Pressure
Absolute and relative hyovolemia and cardiac failure. Improvement in circulatory volume and function, Sympathetic stimulation, Vasoconstriction, Administration of vasopressors
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What is absolute hypovolemia?
blood loss and dehydration
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What is relative hypovolemia?
shock and vasodilation
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is the product of stroke volume and vascular resistance. Therefore, changes in either parameter can affect it.
Arterial pressure
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is the difference between arterial systolic and diastolic pressure.
Pulse pressure (pulse = syst - dias)
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This is an early sign of hypovolemia, decreased stroke volume(hypovoemia), increased blood vessel compliance(shock), and tachycardia all cause this.
Decreased Pulse pressure
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This is an early sign of vol. restoration. Increased stroke vol.(hypervolemia), decreased vessel compliance(arteriosclerosis), and bradycardia all cause this
Increased pulse pressure
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How do you calculate cardiac output?
QT= HRXSV or QT= (130XBSA)/[C(a-v)O2X10] or QT = VO2/[c(a-v)O2 X10]
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What is the noral QT?
406 L/M
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THis is used to normalize QT measurement among Pt's of varying body size.
Cardiac Index (CI)
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What is the formula for CI?
QT/BSA
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what is the normal CI
3-4L/min/m^2
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CI valuse between 1.8- and 2.5 L/min/m^2 indicate?
hypoperfusion
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CI< 1.8 L/min/m^2 may indicative of?
cardiogenic shock
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This is a measurment of the average QT per one heartbeat.
Strove Volume (SV) = QT/HR
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What is the normal SV?
60-120 mL
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Used to normalize stroke volume measurements among patients of varying body size.
Stroke Volume Index (SVI)
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Normal SVI?
33 � 47 mL/m2 (SV/BSA)
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Digoxin (Lanoxin), Dobutamine (Dobutrex), Epinephrine (Adrenalin), Dopamine (Intropin), Isoproterenol (Isuprel), Digitalis, Amrinone (Inocor) are what kind of drugs and what do they do to contractility?
Positive Inotropic Drugs (? contractility)
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Septic shock (early stages), Hyperthermia, Hypervolemia, ? vascular resistance can do what to contractility?
Increase
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Propanolol (Inderal), Metoprolol (Lopressor), Atenolol (Tenormin) are what kind of drugs and what do they do to contractility?
Negative inotropic drugs and decrease contractility.
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Septic shock (late stages), CHF, Hypovolemia, Pulmonary emboli, ? vascular resistance, MI can do what to contractility?
decrease contractility
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what will happen if Transducer or catheter higher than site?
fales low pressure reading
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What will happen if Transducer or catheter lower than site?
false high pressure reading
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What are 3 complications of arterial catheters?
Ischemia, hemorrhage, and infection
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is pressure of the blood in the Vena cava, Right atrium, and Right ventricle. It is also referred to as Right atrial pressure (RAP), right side preload, and Right ventricular end-diastolic pressure
Central Venous Catheter (CVP)
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measures right heart function and fluid levels
cvp
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what is the normal CVP by TRANSDUCER?
0-8 (<8 mmHg)
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What is the normal CVP by MANOMETER?
4-12 cmH2O
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What are the three uses of a CVP?
Assement of R ventric. func. & intravasculad vol. status. Admin. of fluids, nutrition, blood, or drugs. Emergency route for pacemaker insertion.
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Common indications of CVP?
Measure central venous pressure, Administer fluid, blood, or medications, Aspiration of blood samples
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Where is the insertion site of CVP?
subclavian or internal jugular vein
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Where is the CVP located?
superior vena cava near right atrium or withing right atrium
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Decreased venous return (VOLUME!) Absolute hypovolemia, Blood loss - Hemorrhage, Dehydration) or Relative hypovolemia (Shock, Vasodilation) have what effect on CVP?
decreases
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What can increase CVP?
Increased Venous retiurn, hypervolemia, increased intrathoracic pressure, Right heart failure, increased pulmonary vascular resistance, and compression around the heart
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CVP is ideally read at the end of expiration because?
Spontaneous insp. causes CVP to fall and mechanical vent. causes CVP to rise
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What are three complications for CVP?
infection, bleeding, and pneimothorax( greatest hazard)
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When the monitor does not show a sharp waveform, no dicrotic notch. can be caused by Catheter can be obstructed or kinked.
Pressure dampening
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Is an Inadequate tissue perfusion resulting in a hypoxic insult and causing widespread abnormal cell metabolism and membrane dysfunction.
shock
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A decrease in the effective circulating blood volume. cause by hemorrhage or non-hemorrhage ( dehydration and third space fluid space)
Hypovolemic shock
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Is Systemic hypoperfusion due to profound heart failure and/or the ability to meet metabolic needs. End stage of heart disease caused by: MI, Myocarditis, Cardiac tamponade, and Severe valve dysfunction
Cardiogenic Shock
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Shock associated with any infectious disease which causes relative hypovolemia. Caused by many infectious agents, Predisposing factors, Invasive procedures, Organ damage, and Immunocompromised
Septic shock
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A severe illness caused by over whelming infection of the bloodstream by toxin-producing bacteria.
Sepsis
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Dysfunction of the sympathetic nervous system resulting in massive peripheral vasodilation and systemic hypoperfusion. Etiology: Brain or spinal cord trauma, Spinal anesthesia, and Drugs
Neurpgenic shock
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Systemic reaction causing circulatory failure and biochemical abnormalities. Etiology: Drugs, Blood products, Foods, Pollens, and Venoms
Anaphylactic Shock
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