AH3 Hemodynamics

preload measured on the Right vs Left side (and normals)

→ Right: RAP (right atrial pressure)

• CVP

• normal 2-6 mmHg (nickel)

→ Left: PAOP

• PAWP

• normal: 8-12 mmHg (dime)

What is normal CO and PaO2?

CO: 4-6L/min

PaO2: 85-100 mmHg

whats SVO2 (3)

• hows it drawn?

1. relationship b/w O2 delivery and O2 extraction at the tissue level

2. tells u how pt Utilizes O2

3. % of O2 bound to hgb in blood left over, returning to right side of heart

→ drawn from central line or Swan-Ganz

SVO2 normal value?

High vs low:

normal: > 70% (3 quarters)

• High: 70-100 % (aka normal)

• Low:

1. tissues extracting MORE O2 than normal

2. ⬇O2 delivery

SVO2 < 70% means?

tissue extracting more O2 than normal

• septic

Cause of ⬇DO2 delivery? (3) and Increased O2 consumption? (6)

DO2:

1. ⬇hemoglobin

2. ⬇CO

3. ⬇SpO2/SaO2

VO2:

1. shiver

2. increased work of breathing

3. fever

4. infection

5. agitation

6. nursing care

• giving a full bed bath tires pt out

A- Line measures what? (2)

1. MAP

• < 65 bad = Shock

• > 65 good perfusion

2. BP

How is pressure bag and transducer for A-line set up?

• inflate pressure bag to 300mmHg to prevent arterial blood from escaping!!

  • 0.9 NS

• transducer at Phlebostatic axis!!

Phlebostatic axis location?

• Left atrium @ 4th ICS, MCL

What to NEVER do with an A-Line?

Infuse/flush anything through it!!
- its arterial, not venous

What is Pulses Paradoxus?

• causes (3)

• exaggerated BP variation w/ respiratory cycle

  • large drop (> 10 mmHg) in systolic BP when the patient breathes IN.

    
    

• causes:

1. cardiac tamponade

2. COPD

3. asthma

what 3 meds need A-Lines?

• whats their MOA?

1. NE

2. Vasopressin

3. Phenylephrine

• all cause ⬆BP, CO

  • shunts blood back to heart

What meds need/ doesnt need to be tritiated?

Needs:

1. NE

2. Phenylephrine

Doesnt:

1. Vasopressin

NE (6)

• monitor

1. first line med to raise BP

2. monitor for extravasation

• go into tissue instead of blood stream → necrosis

3. digit/gut ischemia

4. bradycardia

5. HTN

6. renal artery vasoconstriction

• ⬇urine output < 30mL/hr x 2 hrs

titrate!!!

Vasopressin (3)

1. 2nd line—additive

2. also for GI bleeding and Diabetes Insipidus

3. no need to titrate—its a set amount

Phenylephrine

• monitor for: (5)

1. extravasation

2. reflex bradycardia d/t vasoconstriction and ⬆BP

3. arrythmias

4. HTN

5. CP

• titrate!!

Central venous pressure shows what?

• placement?

• normal pressure?

measures RIGHT side of heart preload

• jugular, subclavian, femoral vein

• normal CVP: 2-6 mmHg (nickel)

Low vs High CVP number:

Low: “dry

• fluid volume deficit

High: fluid volume overload

Pulmonary Artery Catheter (Swan-Ganz) measures what?

• right side of heart pressure (PAP)

  • high vs low

normal BP in pulmonary artery: 25/10 mmHg

• high: pulmonary HTN

• low: impaired right side HF

Left side: PAOP/PAWP measures what?

• Left Atrial pressure

  • 8-12 mmHg (dime)

  • 
    

PA catheter key balloon rule?

balloon inflated only when moving FORWARD!! never backwards!!

PAWP/PAOP if high means? (6)

1. fluid volume overload

2. LV failure

3. cardiac tamponade

4. constrictive pericarditis

5. high PEEP

6. mitral stenosis