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Hemodynamic &vaso me

Hemodynamic meds and vasoactive meds

What are the system components of hemodynamic monitoring? Pressure Bag, Pressure tubing, Stopcocks,Blood sampling port, Transducer, Monitor Wagner pg 254 know these
What is the Phlebostatic axis: Level of left atrium 4th ICS & ½ AP diameter Mark the chest with washable felt pen
An underdamped waveform has Artificially spiked waveform, False ↑ SBP, False ↓ DBP
An overdamped waveform has Sluggish, rounded wave False ↓ SBP False ↑ DBP
The diortic notch reflects closure of aortic valve
What are the normal values for central venous monitoring of CVP? CVP: 2-6mmHg
What is the normal Ejection Fraction: 60-70%
What is the normal Sv02? SvO2: 60-80% v) MAP= SBP+2(DBP)/3
What is the normal value for EtCO2? 35-45 mmHg
What is the normal value for MAP? SBP + 2 (DBP)/3 Avg 70-90mmHg
Why is central venous monitoring done? i) To monitor fluid status on the right side of the body and heart ii) Part of the “SEPSIS PROTOCOL” (1) Level transducer to Phlebostatic Axis (a) Level of the Left atrium (b) 4th ICS and ½ AP diameter (c) Mark the site for CONSISTENT LEVELING
What is the purpose of pulmonary artery (PA) catheters ? To obtain right heart & PA pressures To determine CO/CI To obtain mixed venous blood samples from the PA (Sv02)
What are the advantages of PA catheters? i) Advantages (1) Real-time Data with ability to monitor hemodynamic parameters simultaneously (2) Rapidly assess patients response to interventions.
What are the disadvantages of PA catheters ii) Disadvantages (1) INFECTION (2) Insertion complications (bleeding, dysrhythmias, exsanguination and air emboli)
What is preload? The force or load on the ventricle during the relaxation phase
Preload “Filling Pressures” or filling the tank AKA: “volume” Right Ventricular End Diastolic Volume (CVP) Left Ventricular End Diastolic Volume (PAWP) The degree of stretch in myocardial fibers at the end of diastole IE: A function of volume and ventricular compliance
Volume factors affecting preload venous return total blood volume atrial kick*** loss of this Atrial kick results in loss of extra pressure to move blood through)
Compliance factors affecting preload stiffness and thickness of ventricular wall Basically the ability of the ventricles to accommodate the volume of blood. Less compliance= MORE stiffness
s/sx of preload if increased Pedal Edema S3, S4 Crackles Dyspnea Ascities, hepatic engorgement JVD
s/sx of preload if decreased Tachycardia  Spec Gravity Dry mucous membranes Orthostatic hypotension Low U/O
What is afterload? The force or load on the ventricle during the ejection phase of the cardiac cycle (Simply: The resistance against which the heart is pumping blood!)
Afterload can be affected by: aortic impedance, blood viscosity, blood volume and vascular tone
(Afterload) Systemic Vascular Resistance (SVR): Resistance to ejection from left side of heart
(Afterload) Pulmonary Vascular Resistance (PVR) Resistance to ejection from right side of heart
Increased Afterload: (vasoconstriction) Cool, clammy skin, HTN,Non-healing wounds Thick, brittle nails, "Can't feel the warmth" RATIONAL: These symptoms should reflect the vasoconstriction the patient is experiencing. Vasoconstriction results in decreased blood flow (in periphery) and INCREAS
Decreased Afterload: (vasodilation) (Vasodilation) Warm, flushed skin, Increased CO "feel the warmth" RATIONAL: These symptoms should reflect the vasodilation that the patient is experiencing. Vasodilation is going to increase the cardiac output which is a function of stroke volume and
Goal of vasoactive medications Maintain MAP >65 mmHg, Systolic BP above 90 and below 180 and HR between 60-130bpm. ii) ***BEFORE ADMINISTRATION: REUSCITATION OF FLUIDS!
What do they do :Beta blockers- (-olol’s) decrease sympathetic stimulation of the heart resulting in decreased HR and BP.
What they do: CCB’s- (Verapamil, Nifedipine, Diltiazem) block calcium channels and decreased intracellular calcium, decreasing muscle contraction thereby decreasing PRELOAD and AFTERLOAD
Iontropic Agents-(Digoxin, Dobutamine) Increase intracellular calcium thereby increasing contractility.
Vasopressors (Vasopressin, Dopamine, Phenylephrine, Levophed)- Increase vasoconstriction
Vasodilators/Antianginal (Nitric oxide, Nesiritide/Nitroglycerine) increase vasodilation to decrease preload
Anticholinergic Agent- (Atropine) Inhibits the release of AcH and Vagus response (which is absent in heart transplants- use Epinephrine) Used primarily for symptomatic bradycardia.
Antihypertensive (Nitroprusside, Hydralazine)- Potent vasodilator used for HTN CRISIS
Antiarrhythmic, anesthetic( Lidocaine, amiodarone)- Supresses automaticity and spontaneous depolarization
With amiodarone: (Infuse via Central line and use filter, also…) (a) INCREASES protimes, (b) monitor liver enzymes (c) Can cause pulmonary toxicity (d) CONTRAINDICATED IN sinus brady or 2/3rd degree AV BLOCK.
Antidiarrheal (Sandostatin)- DON’T BE FOOLED THIS ISNT A LIPID LOWERING DRUG! (1) Used to inhibit the release of GH in acromegly suppresses serotonin (2) Used for severe diarrhea and flushing in patients with GI/endocrine tumors (3) UNLABELED USE: GI bleeds
Created by: UARN85