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2brt hemodynamic
hemodynamic monitoring
| Question | Answer |
|---|---|
| What are artifacts | spikes or shifts in values not constant with pt clinical status Ex: pt moving lines |
| Factitious | real events that may require attention. Ex: changes in BP |
| How do you determine tissue oxygenation | through ABG or pulse ox Depends on PIO2, PAO2, CaO2, DO2, tissue perfusion and O2 uptake |
| What ways can you monitor Spo2 | Pulse OX, monitor, and ABG |
| What can cause errors in messuring SPO2 | motion from shivering, seizure activity, pressure on senor, or patient transport, probe site placement, intense light, anemia, colored skin, carboxyhemo, methemoglobin, dark nail polish, some blood born dyes |
| normal value O2 consumption | 250/ml |
| what causes O2 consumption to increase | activity, stress, and temperature |
| Method used to mesure O2 consumpttion | Fick method Qt=VO2/(CAO2-CVO2) VO2=QT/(CAO2-CVO2) |
| normal range for P(A-a)O2 | 5 to 15mm hg |
| equation for estimating % of shunt | breathing 100% [P(A-a)O2]/20 |
| If I have a P(A-a)O2 of 300 mm hg while on 100% o2, what is estimated shunt? | 15% |
| normal PaO2/FIO2 ratio ALI ARDS | 400mg to 500mg normal <300 ALI <200 ARDS |
| parameters considered most accurate and reliable measure of oxygenation efficiency | 5 to 15 mm hg |
| normal range for VD/VT | dead space/tidal volume ratio 0.20 to 0.40 |
| best messure of efficiency of gas exchange in the lungs | VD/VT ratio Paco2-Peco2/Paco2 |
| which disorders will cause an increase in VD/VT | CHF, PE, ALI, Pulmonary hypertension, and Pt's undergoing mech. ventilation. |
| What VD/VT value indicate that weaning is not likely | >0.60 is predicitive of lack of success |
| what will lead to an increased end-tidal PCO2 | *increased effective ventilation >VT >VE >VA *Marked < in effective ventilation *< carbon dioxide production (VCO2)(sedation, sleep, cooling) *< in lung perfusion (PE, |
| lung compliance and normal range | measure of stiffness of the lungs 60 to 100ml/cm H2O |
| RAW and normal RAW | Airway resistance determined by simutaneous measurments of airway flow and presure. normal RAW 1 to 2 cm Hg Intubated pt. 5 to 10 cm Hg |
| equation for RAW | Diffrence between airway opening Pao2 and the alveoli PALV R = (Pao2-Palv)/flow |
| condition associted with an increased lung compliance | improvement in atelectasis, pneumonia, Pulmonary edema, ALI, ARDS, pnemothorax, fibrosis, bronchial intubation, increased thoracic compliance, improved obesity, ascites, chest wall deformaties like flailed chest |
| What are caused of increased airway resistance | *small ET tube, plug in ET tube, bitting on ET tube *Bronchospasm and mucosal edema *secretions *airway obstruction *high gas flow rate |
| What are the limits for plateau airway pressure in a pt. receiving MV? Why? | not exceed 30mg hg because elevated Pplat increases chances of vent induced lung injury |
| factors associated with an increased risk for auto peep? | dynamic hyperinlation can develop even at low VE alters trigger sensitivity on vent |
| factors that contribute to development of auto peep | Expiratory muscle weekness, mech ventilated patients with COPD Pt with high VE, ARDS |
| peak presure increases due to? | either increased resistance or decreased compliance. if they move up together the problem is compliance. when peak pressure increases and plateau stays the same problem is airway resistance. |
| breathing pattern suggesting resp. muscle decompensation? | Cheney Stokes |
| What bedside parameters are used to assess resp mucle strength? | VC >or= 70ml kg <10 to 15 muscle weakness MIP maximal inspiratory pressure >-20 to -30 |
| normal VC | 70ml/kg |
| what does decreased capacity indicate | muscle weakness |
| why do we use ventilatory graphics | to monitor pt's vent interaction. allow rapid determination of mode, B pattern, auto peep, excessive presure, secretions in airway, synchrony, and triggering efforts, and WOB |
| what is MAP and MAP normal ranges | Mean arterial Blood pressure 90mm hg (80-100) |
| what is CVP and CVP normal ranges | central venous pressure. same as right arterial ranges 2 to 6mm hg |
| range for mean pulmonary artery pressure? | 15mm hg |
| what is cardiac output and normal CO | vol of blood pumped per minute by the heart normal 5 L/min (4-8) |
| what is PCWP and what is PCWP normal range? | Pulmonary capillary wedge pressure 5-10mm Hg (<18) |
| What is CVP associated with increase CVP | fluid overload, R ventricular failure, pulmonia, hypercapnia, valvular stenosis, PE cardiac tamponade, pneumothorax, PPV, PEEP, L ventricular failure |
| What is associated with increased PAP | pulmonary hypercapnia, left ventricular failure, fluid overload |
| What is associated with increased PCWP | left ventricular failure, fluid overload, > 20 intersticial edema, >25 alveolar filling, >30 frank pulmo. edema |
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laura2brt
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