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CRITICAL CARE AIRWA CORYR MAECNAGT QUEEMESTIONTN & US APNPDE RC (^) ORRERSEPIRCTA ATONSRWY (^) EERXAMS!! 2 QUESTIONS AND What are the three values used to evaluate the forces influencing blood pressure?(1) CVP (central venous pressure) (2) PAP (pulmonary artery pressure)(3) PCWP (pulmonary capillary wedge pressure).
What three factors affect blood pressure?(1) The condition of the left ventricle (the pump) (2) The volume of blood in the cardiovascular system (the volume)(3) The relative size of the intravascular space (the space).
Which ventricle is composed of more muscle?The left ventricle.
Where is the majority of the systemic blood stored in the body?In the veins.
What happens during inspiration?The drop in negative pressure in the thorax from -2 to -5 helps suck blood back toward the heart.
What is the Swan-Ganz catheter?An invasive method of measuring pressure within the heart and lungs.
What is another name for the Swan-Ganz catheter?The triple lumen catheter.
What is shock?It is a lack of blood flow to any tissues/organs in the body.
What is the distal lumen?The fluid-filled line that transmits a wave of pressure from the tip of the catheter to the transducer. What is a transducer?A device that converts one form of energy to another. The transducer converts the pressure signal to an electrical signal then sends it on to the monitor. What does the monitor amplify?It amplifies the signal and displays digital readings and/or a waveform.
What does the distal port communicate with?
The proximal port is also known as what?The central venous pressure port.
Where is the CVP port located?At the top of the right side of the heart, where the superior vena cava goes into the right atrium. The lumen opens how many centimeters from the catheter's port?30 cm
How is cardiac output measured?By injecting a bolus of saline at a known temperature that is less than the body's, into the proximal lumen. What does the SVO2 measurement tell us?How much oxygen the body is using.
What is a normal SVO2 value?70%
What measurement is the closest to the left side of the heart?
PCWP
What is the formula for cardiac output?CO = HR x SV
Where can you obtain the PaO2?In a blood gas sample.
Where can you find the PVO2?Mixed venous blood obtained from the distal (PA) port of a Swan-Ganz catheter.
Where is the SVO2 obtained from?The optical module connector in the top of the line Swan-Ganz catheter.
VO2 is the amount of what?Oxygen that the body extracts from the blood every minute in order to feed the tissues.
What blood vessel comes in at the top of the right heart?The superior vena cava.
15-28 mmHg What is a normal right ventricle pressure for diastolic?0-8 mmHg
What is the normal systolic pulmonary artery pressure?15-30 mmHg
What is the normal diastolic pulmonary artery pressure?4-12 mmHg
What is the normal mean pulmonary artery pressure?6-18 mmHg
What does the dicrotic notch represent?The closure of the aortic & pulmonic valves @ the end of systole
What does it indicate when there is no dicrotic notch?You may have to reposition the catheter or the patient was possibly moving.
What happens each time the mitral valve opens?There is a direct communication between the catheter tip and the left ventricle via pulmonary capillary bed. What is a normal mean of PCWP?6-12 mmHg
How do we know if someone is in shock?They will demonstrate the following: decreased urinary output, decreased blood pressure, cyanotic, temperature changes of skin and cerebral perfusion compromise. What does cardiogenic mean?Beginning at the heart.
What is cardiogenic shock?Left ventricular failing as a pump.
What pressure is closest to the left ventricle?PCWP
Patients with CHF will have what?An increased PCWP.
How do you know that a patient has CHF based on their chest x-ray?Measure the CT ratio and if it is > 50%, CHF is likely.
What happens when left ventricular failure gets worse?Blood begins to back up into the left atrium.
What pressure is measured in pulmonary arteriole?PCWP
Which factors are not affected by cardiogenic shock?The skin's color and temperature.
What does peripheral edema cause?An increase in heart rate.
What can happen if you give a patient too much positive pressure on a ventilator?It can cause cardiac tamponade (because it will squeeze the heart), among other things.
How is cardiac output affected in cardiogenic shock?
The left ventricle is failing so cardiac output is decreased. What drugs would you give to increase cardiac output?Positive Inotropes (digitalis, digoxin), which will increase the contractility of the heart.
What is the total amount of blood volume in the venous system is?64%
Venous return is the amount of blood volume returning to the?Right heart.
The patient cardiac index is the cardiac output based on what?Actual body size.
What is end-systolic pressure?The amount of blood in the ventricle after ejection.
70 What is end-diastolic pressure is?The amount of blood in the ventricle after filling.
What is preload?The stretch on the ventricle muscle fibers before contraction.
What is afterload?The resistance of external factors that oppose ventricular contraction.
Stroke volume is determined by what?Preload, afterload, and contractility.
A decrease in potassium and sodium causes what?Atrial fibrillation.
What is the procedure for placing an arterial line?Assemble all equipment, perform the Allen's test, drape the patient, inject 1% lidocaine, insert the catheter at a 30-degree angle, hold the needle and advance the catheter,remove the needle and secure, attach drip and observe the waveform.
What is the procedure for placing a pulmonary catheter?It is done by the physician, check the balloon for patency, it is inserted into a selected sight until it reaches the right atrium, then inflate the balloon.
What are the common sites for placing a pulmonary catheter?Subclavian or internal jugular vein.
What are the common sites for placing an arterial catheter?Radial, brachial, or femoral arteries.
What is Systemic Vascular Resistance?It is the pressure on the vessel's throughout the body (from the aorta).
What is Pulmonary Vascular Resistance?It is the pressure on the pulmonary artery.
What factors affect the contractility of the heart?Coronary blood flow, sympathetic nerve stimulation, Inotropic drugs, Physiologic depressants, damage to heart. What are the left atrial filling pressures?Preload and PCWP.
What are the right atrial filling pressures?The amount of blood in the right atrium or CVP.
What does an increase or decrease in CVP represent?An increase represents fluid overload, L-R shunt, cor pulmonale. A decrease represents hypovolemic shock. Why should all blood pressure measurements be taken at the heart level?To eliminate the effect of gravity on hydrostatic pressure.
What is the definition of stroke volume?The volume of blood ejected from the heart with each beat.
How does heart rate affect diastolic pressure?It changes the duration of diastole and the pressure continues to fall until the next systole. This is an early sign of changes in circulating blood volume?Changes in Pulse pressure.
Low pulse pressures can indicate what two things?CHF and shock.
What is the average driving force in the arterial system throughout the cardiac cycle
known as?Mean arterial pressure (MAP)
MAP can be used to calculate what?SVR and PVR
What is the normal for MAP?70-
An MAP below 60 indicates what?Circulation to vital organs may be compromised and poor tissue perfusion.
What are the indications for Arterial cannulation?It's indicated for hemodynamically unstable patients, patients on vasoactive drips, patients with IAB, and perioperative patients. What are the hazards of arterial cannulation?Hemorrhage, thrombus, air embolism, systemic infection, site infection, arterial spasm, vascular occlusion. Why is invasive hemodynamic monitoring needed?Because clinical assessment alone may not accurately predict hemodynamics.
Where is the arterial catheter usually placed?Radial, ulnar, brachial, axillary, femoral.
Where is the arterial line most often placed and why?The radial artery, because it is readily accessible/adequate collateral circulation.
What is low blood pressure a late sign of?Deficits in blood volume or cardiac function.
What are the causes of hypotension?Low blood volume (bleeding), cardiac failure/shock (heart attack), vasodilation (sepsis).
During the administration of what drugs should the diastolic pressure be watchedcarefully? Vasodilators, such as sodium nitroprusside. What are 6 causes of an increased central venous pressure?Fluid overload, heart failure, pulmonary hypertension, tricuspid valve stenosis, pulmonary embolism, and increased venous return. What are the 4 causes of a decreased central venous pressure?
Vasodilation, reduced circulating blood volume, leaks in pressure system/air bubbles,spontaneous inspiration.
When can pneumothorax occur during hemodynamic monitoring?Then the catheter punctures the pleural lining.
What can the accidental opening of the central venous line stopcock allow and result in?Air to enter the vein which can cause an air embolus.
What does the PAC allow the assessment of?It allows the assessment of the filling pressures of the left side of the heart.
What are pulmonary artery catheters also called?Swan-ganz catheters
What is the balloon at the tip of the catheter used for?To float the catheter into position (into the right side of the heart and into the pulmonary artery) and obtain wedge pressure measurements. What can resistance to pulmonary flow (increased PVR) be caused by?Constriction, obstruction, or compression of the pulmonary vasculature or backpressure from the left heart.
