CP 2013 Viva study

• 145- HR
• 89- MAP
• 100- SpO2

• - evaluate health
• - guide treatment
• - evaluate effects of treatment
• Gives you regular/ continuous recording and evaluation of physiological functioning

• - general systemic observations
• - cardiovascular system
• - haemodynamics
• - respiratory system
• - CNS
• - renal/ kidney
• - other

• - treating pts who are monitored 
• - need to use the information from monitoring to guide management decisions
• - safety with moving pts and handling monitoring equipment (dont want to pull something out)

• - Obs- frequency depends on the status of the pt
• - obs are on bed chart in general ward setting
• - obs are on flw chart in critical care setting
• 

• - monitoring involves the sensing of physiological parameters and then turning this into a displace
• - very complex but involves:
• * a sensor to pick up physiological change
• * an amplifier to increase the magnitude of the signal
• * a recording/ displace of the signal
• - transducer turn pressure changes into waveform display
• - pressure transducer- piezoeletric crystal which converts pressure canges into a voltage change then converted to a trace
• - pressure transducers need to be zeroed against the point at which the catheter tip isassume to rest- for cardiac pressures- normally 4ICS, M.A.L
• - the transducer needs to be in the right place for it to deliver an accurate reading- haemodynamic messures = RA (point of right atrium when you stand up)

- ECG

• - CVP
• - BP
• - CO and chamber pressures
• - PAP (pulmonary artery pressure) 
• - PCWP (pulmonary capillary wedge pressure)

• - pulmonary capillary wedge pressure
• - 8-12mmHg

MAP = DBP + SBP - DBP/ 3

90-100mmHg

- cuff

• - arterial blood line
• - transducer needs to be at the level of the right atrium
• - movt may compromise trace

• - arterial BP
• - systolic pressure (peak)
• - dichrotic notch- need this trace to know if it is an accurate reading
• - diastolic pressure
• - pulse pressure is all of the above
• - MAP- straight line thru reading
• - for more info look at lecture

- ABGs

- central venous pressure

- thru a venous line from the SVC (superior vena cava) (right arterial pressure)

• - intravascular volume status 
• - RV preload

• - 0-5mmHg
• - 3-15cmH2O
• Note when dead CVP= 5
• - not overly useful but good for understanding fluid levels/ balance

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- swan ganz catheter

- at lot of places wont let you

• - pulmonary artery pressure
• - pulmonary wedge pressure

• - balloon tipped, flow directed catheter
• - mulitple lumen- along tube
•    - distal port PA
•    - proximal part- CVP
• - indicated when precise measurements of cardiac status are neede
• - not used alot

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- once it occludes the PA it is measuring the PCWP

- 8-12mmHg

• - pressure in the pulmonary capillaries
• - unrestricted vascular channel thru the PA, pul vasc bed, PV, LA and LV (when mitral open)
• - reflection of the pressures in the left atrium and therefore left ventricular diastolic (LVEDP)
• - if LVEDP increases there is an increase is LVEDV - volume
• - also measure pulmonary fluid overload

• - pulmonary congestion- 18-20 (interstitual)
• -pulmonary oedema if >20-30 (fluid in arterial space)
• - if colloid osmotic pressure is decreased (albium) pulmonary oedema will occur at a lower PCWP

• - PCWP 18-20
• - interstitual

• >2030
• - fluid in arterial space

Hypovolaemia

is a state of decreased blood volume; more specifically, decrease in volume of blood plasma

• - pulmonary disease and pulmonary vascular disease
• -increased pulmonary blood flow (left to right shunt)
• - positive pressure ventilation

• - thermodilution
• - temp change

4-7l/min

approx 3L/min/m2

• - dysrythmias
• - pulmonary infection
• - balloon rupture
• - damage to PA
• - thrombolitic effects
• - infection
• - kinking or twisting of the line
• - misplacement
• These are the reasons why they are moving away from these

• - intra- aortic balloon pump
• - form of cardiac support
• - used for pts waiting for heart replacements
• - helps increase pressures

• - increases LVEDP
• - ↑ coronary blood flow

• - decreases LV afterload
• - increases CO
• - decreases work- decrease oxygen consumption
• - increase diasotlic pressure for blood to get around
• - guided by an ECG

• - in the arch of the aorta
• - inflated balloon- on a systolic contraction
• 

-lower

• - respiratory status and right heart function than PCWP
• - Not PAPD is closely related to PCWP

• - moving ECG lines
• - Dont do percs and vibes
• - Don't sit up past 30 degrees hip flex

• - both will be affected
• - heart failure

• - heart failure
• - failure to wean from CPB (cardiopulmonary bypass) eg post cardiac curgery
• - prophylatic- transplant

• - limb ischaemia
• - vascular trauma- dissection of artery
• - infection
• - balloon rupture
• - haematological complications
• - malposition- kinking

• - IABP
• - VAD
• - ECMO

• - ventricular assist device
• - helps the ventricles work
• - temporary device- can be external or implantable
• - can be a continuous flow or not

• - blood withdrawn from the heart chamber
• - pumped through device
• - returned to outflow (aorta/PA)

• - bridge transplant
• - post op heart failure

• - extra corporeal membrane oxygenation
• - bi- ventricular bypass
• - used recently for influenza outbreaks
• - being used more and more
• - if pt very ill place them on their belly

• - saturation
• - arterial blood gases
• - end tidal CO2
• - ventilator settings

- ICP

• - traumatic brain injury
• -trying to prevent secondary complicaitons

• - near the site of the lesion
• - it is linked to a transducer which converts pressure to a plethymographic trace and number

• - Epidural - not a accurate
• - subarachnoid/ subdural
• - intraventricular 
• 

• - CPP (MAP- ICP)
• - glascow coma scale
• 

MAP - ICP

- acute renal failure

- chronic renal failure

• - spesis
• - mulitorgan failure
• - hypoglycemic 
• - if urea and creatine are rising above normal levels

• - control fluid balance
• - control electrolyte balance
• - control acid base
• - get rid of toxins and drugs

- the removal of solutes and water via a semipermeable membrane- either biological or artificial

• - arterial or venous
• - external pump or own driving pressure
• - haemofiltration or haemodialysis

• - blood pumped through extracorporeal system, separated by a semipermeable membrane from a dialystate soution- diffusion of substances across an electrochemical gradient, fluid goes across by haemostatic pressure
• - 4-6hrs
• - poorly tolerated by critically ill pts
• -take out and clean then put back in

• - removal of water and solutes by diffusion and convection 
• - hydrostatic pressure drives filtrate through the membrane and solutes are taken across
• - lost liquid is replaced with plasma
• - slow- takes 24hrs
• - pressure changes affect how well it works
• - can be used continuously

• - CVVHD- continuous, veno- venous haemofilations with dialysis
• - CAVHD- continuous, arteriovenous haemofiltration with dialysis
• - CRRT- continuous replacement therapy

• - use the peritoneum as a semipermiable membrace
• - not as effective as HD- therefore not used in critically ill patients

• - infection
• - impair diaphragm function
• - cant walk around with it

• - know what the monitors are- ask and what info u can get from them
• - the equipment itself doesnt have CI to physio- the underlying pathology might be
• - dont pull stuff out
• - alarms- know what to do if they go off
• - treating pts- make sure transducers are at the right level, monitor pt, safety, stop and check etc
• Head down tip CI for highICP