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Hemo Final Exam

What pressures are measured by pressure lines? CVP, PAP, RV, RA, PCWP
What is the normal value for MAP? 70 - 105 mmHg
What is the normal value for CVP? 2 - 6 mmHg
What is the normal value for PAP? 15-25/8-15 mmHg
What is the normal systolic PAP (RV function)? 15 - 25 mmHg
What is the normal diastolic PAP (PVR)? 8 - 15 mmHg
What is the normal systolic RV pressure? Contractility of the RV - 15 to 25 mmHg
What is the normal diastolic RV pressure? Filling pressure of the RV - 0 to 8 mmHg
What is the normal RA (CVP) pressure? 2 - 6 mmHg
What is the normal PCWP? 4 - 12 mmHg
What are the indications for A-Lines? Frequent ABG sampling, continuous invasive BP monitoring (hemodynamically unstable patient, assessment of therapeutic interventions), dye dilution C.O.
What equipment is needed to set up for an A- Line? Iodine, sterile gloves/drape, local anesthetic, several catheters/needles, flush system - transducer, pressure bag, heparinized saline
What does the Anacrotic Limb of the A - Line waveform represent? Represents increased of arterial pressure during systole, aortic valve is open
What does a fast upstroke of the Anacrotic Limb represent? Aortic valve regurgitation or "hyperdynamic" heart
What does a slow upstroke of the Anacrotic Limb represent? Aortic stenosis or ventricular failure
What does the Dicrotic Notch of the A-Line waveform represent? Caused by closing of aortic valve during diastole
What does the Dicrotic Limb of the A-Line waveform represent? Represents decrease of arterial pressure during diastole, aortic valve is still closed
What is the normal value for Cardiac Output? 4 - 8 LPM (5 LPM)
What is the normal value for Stroke Volume? 70 mL
What is the normal value for PVR? 8 - 15 mmHg
What is the normal value for SvO2? 75%
What is the normal value for MAP? 70 - 105 mmHg
What is the equation for Cardiac Output? CO = SV x HR
What is the Fick Equation used to find? Cardiac Output
What is the Fick Equation? VO2 / (av diff x 10)
What is the equation for MAP? Systolic + 2(diastolic) / 3
What is the equation for PAO2? [FiO2(Pb-PH2O)] - [PaCO2(1.25)]
What is the equation for AaDO2? PAO2 - PaO2
What is the equation for AV difference? CaO2 - CvO2
What is the equation for Shunt? QS/QT = CcO2 - CaO2 / CcO2 - CvO2
What is the equation for Deadspace? VD/VT = PaCO2 - PeCO2 / PaCO2
Define Afterload Resistance of the blood vessel that the ventricles have to pump against to eject blood
Define Preload Force exerted by the blood on the walls of the ventricles at the end of diastole; filling pressure of the ventricles (end-diastolic is the same as preload)
Define Diastole Lowest pressure of the heart at rest; relaxation of the heart; bottom number of BP
Define Stroke Volume Amount of blood ejected by ventricles in one contraction (Normal = 70 mL)
Define Systole Highest pressure during contraction; pumping of the heart; top number of BP
Where should the gastric bubble be seen on CXR? No more than 2 cm above dome of diaphragm
Where should the diaphragm be seen on deep inspiration? Diaphragm descends to 6th anterior rib and 10th posterior rib
What causes the diaphragm to be elevated on CXR? Right side is normally 1 - 2 cm higher than left (liver); atelectasis, increased pressure in abdomen
What causes the diaphragm to be depressed on CXR? Hyperinflation, air trapping
What is the Costophrenic Angle? Anatomic junction of diaphragm and lung pleura
What do blunted costophrenic angles indicate? Pleural effusion
What do elevated costophrenic angles indicate? Increased abdominal pressure or atelectasis
How many heart bulges are on the right side of the heart? 2
What do the two heart bulges on the right side of the heart represent? SVC and RA
How many heart bulges are on the left side of the heart? 3
What do the three heart bulges on the left side of the heart represent? Aortic knob, main PA, LV
What is the normal size of the heart on CXR? Should be 50% or less than width of thorax at diaphragm level
What is the Posterior - Anterior (PA) X- Ray technique? Patient is upright, front of chest on film, shoulders forward, deep breath in and hold - shows least cardiac distortion
What is the Anterior - Posterior (AP) X-Ray Technique? Portable CXR (vented patients), patient is sitting up or lying supine with film behind back - can magnify organs due to closeness
What is the Lateral X-Ray technique? Upright with left side against film (always left), arms raised above head, deep breath in and hold - allows you to seen behind heart and diaphragm
What is the Lateral Decubitus X - Ray Technique? Determines extent of pleural effusion or pneumothorax after seen on AP or PA - Patient lies on either side in "lateral recumbent" position (pillow under head, arms raised over head, knees slightly bent)
When taking a Lateral Decubitus X-Ray of a patient with a pneumothorax, how should the patient be positioned? Air side up
When taking a Lateral Decubitus X-ray of a patient with a pleural effusion, how should the patient be positioned? Fluid side down - fluid spreads up
What is the Apical Lordotic X-Ray technique? Best view for seeing RML and tops of lungs (apices), used to detect location of tumors, obstruction, collapse - patient leans back at 30-45 degree angle or patient is upright and xray beam is angled up at 30-45 degree angle
What does a tracheal shift away indicate? Pneumothorax
What does a tracheal shift towards indicate? Atelectasis
What does reticular indicate on CXR? CHF, RDS (fluid), "net appearance"
What do no vascular markings on a CXR indicate? Pneumothorax
What is an MRI? Magnetic Resonance Imaging, uses magnets and radio waves to get cross sectional images; NO ionizing radiation
What is a CT scan? Computer aided tomography, takes x ray image in slices; uses radiation
What is Fluoroscopy? Dynamic/moving picture; used for bronchoscopy with biopsy, feeding tube placement, swallow studies, difficult PICC line insertion
What does an angiogram look at? Blood flow
What does a bronchogram look at? Air flow
What does a V/Q scan look at? Pulmonary emboli
What is the best technique for finding a pulmonary emboli? V/Q scan
What does CVP measure? Right heart function
What is normal CVP? 2 - 6 mmHg
What does PAP measure? Pulmonary Vasculature
What is normal PAP? 15-25 / 8-15 mmHg
What does PCWP meaure? Left heart function
What is normal PCWP? 4 - 12 mmHg
Where is the distal port of the PAC placed? PA
What does the distal port of the PAC measure? PAP
Where can you obtain a true venous sample from a PAC? Distal port
Where is the proximal port of the PAC located? RA
What does the proximal port of the PAC measure? Right Atrial Pressure
What does the Thermistor of the PAC measure? Cardiac output and temperature
What does the balloon valve of the PAC do? Inflate balloon
What causes increased CVP? Increased preload and afterload, hypervolemia, decreased contractility, tricuspid stenosis, clot in line, patient and/or position change
What causes decreased CVP? Hypovolemia, patient and/or transducer position change, decreased venous return
What causes increased PAP? Increased pulmonary blood flow, hypervolemia, pulmonary vasoconstriction, pulmonary HTN
What causes decreased PAP? Pulmonary vasodilation, hypovolemia
What causes increased PCWP? Cardiac tamponade, LV failure, hypervolemia, mitral valve regurgitation, mitral valve stenosis, pneumothorax, mechanical ventilation, high PEEP effects, aortic valve issues
What causes decreased PCWP? Hypovolemia
What should be done if there is a sudden change in PAC waveform? Adjust position of catheter, either advance further or pull back till PAP waveform is seen
What is the PAC balloon used for? To obtain PCWP
How much air does the PAC balloon hold? 1.5 mL
How should the PAC balloon be deflated? Passively
What is a thoracentesis used for? To remove air or fluid from the pleural space
How should the patient be positioned for a thoracentesis? Patient sits upright on side of bed, feet support, and arms on bedside table
What are chest tubes used for? Pleural effusion or pneumothorax
When should a chest tube be used instead of a thoracentesis? When more the 2000 mL need to be removed or when continuous drainage of re accumulating fluid is seen
Where should a chest tube be placed to remove air? Midclavicular in 2nd, 3rd, or 4th intercostal space
Where should a chest tube be placed to remove fluid? 5th or 6th intercostal space, midaxillary line
Where should the chest tube be placed if both fluid and air are found? Need 2 tubes, superior to wound site in anterior chest and inferior to wound site in posterior wall
What should be done if there is a break in the water seal of the chest tube drainage system? Place in glass of water (clamp it)
What are possible causes of no bubbling in suction bottle? Suction to low or off, leak in system, control straw block
How do you correct no bubbling in suction bottle? Increase suction, fix the leak, replace or reposition straw
What causes water to splash out of the water seal bottle? Suction set too high, correct by turning down suction
What causes no bubbling in water seal bottle? Pneumothorax resolved, no air coming out of pleural space
What should be done if the chest tube is pulled out? Cover hole in chest immediately, replace tube
What is the SVC pressure? 0 mmHg
What is the Aorta pressure? 120/80 mmHg
What is the PA pressure? 15-25 / 8-15 mmHg
What is the RA pressure? 2-6 mmHg
What is the RV pressure? 15-25 / 0-8 mmHg
What is the LA pressure? 8-12 mmHg
What is the LV pressure? 110/10 mmHg
What is the pulmonary capillary pressure? 12 - 17 mmHg
What is the capillary pressure? 30-50 mmHg
What are the indication for IABP? CHF, acute MI, cardiogenic and septic shock, unstable or pre infarct angina, cardiac contusion, bridge to CABG or heart transplant, circulatory support post CABG, mechanical defects
What mechanical defects are indications for IABP? Mitral regurgitation, ventricular septal wall defects, ventricular aneurysm, aortic stenosis
What are the absolute contraindications for IABP? Aortic valve insufficiency, aortic dissection, chronic end-stage heart disease (not on transplant list), other end stage terminal disease, severe arteriosclerosis (preventing insertion)
What are the relative contraindications for IABP? Aortic aneurysm, vascular aortic or aortofemoral grafts
What are possible complications during insertion of IABP? Aortic dissection, dislodging of plaque, inability to pass catheter, obstruction of femoral blood flow
What are possible complications during pumping of IABP? Bleeding, decreased leg circulation, thrombosis (immobile), perforated aorta, blood embolism, gas emboli (balloon rupture), inability to wean, cardiac compromise (timing off)
What are possible complications during removal of IABP? Bleeding, emboli, dislodging of plaque
What are possible complications post removal of IABP? Relapse of condition, hematoma, bleeding
What gas is used for IABP? Helium
Where is the IABP inserted? Through left or right femoral artery
How do you wean a patient from IABP? Increase time off balloon, decrease balloon inflation volume, decrease frequency of inflation
What is the weaning criteria for IABP? HR < 110, MAP > 70 with minimal drugs, PCWP < 18, no arrhythmias or CHF, clotting time < 180 seconds, good peripheral perfusion - color, temp, pulses, mental status, urine output
What is the best timing for IABP? 1:1 or 1:2
What is SvO2? Saturation of Hgb with O2 in venous blood
What does SvO2 tell us? Tissue oxygenation and consumption, how well tissues tolerate QT and BP changes
What does low SvO2 indicate? Increased tissue consumption
What is normal SvO2? 75% (60 - 75%)
How can you physical assess QT? Urine output, HR, BP, cap refill, LOC, temp, color, neck vein distention, pulse pressure, appearance
What is the most common arrhythmia associated with hypovolemic shock? Sinus tach
What is stroke volume dependent upon? Pre load, afterload, contractility
What affect does decreased contractility have? Decreases preload and afterload because CO is decreased
When should medications be used to increase contractility? Low SV, low SvO2, increased PCWP, decreased contractility
What medications should be used to increase contractility? Vasodialte with dobutamine, dopamine, epinephrine, norepinephrine
What are the dilution methods? Thermal and Dye
What lines are required for dye dilution? CVP, PAC, A-Line
What lines are required of thermal dilution? PAC
What are the causes of hypovolemic shock? Loss of fluid, internal hemorrhage, extensive bleeding, severe burns, trauma, organ damage
What are the signs of hypovolemic shock? Anxiety, restlessness, altered LOC, hypotension, cool clammy skin, weak thready pulse, rapid deep breathing, dry mouth, thirst, fatigue
What is the 1st line of action for all shock? Increase blood volume (blood, IV fluids, albumin)
What is the treatment for all shock? Restore fluid balance, maintain airway, maintain pump, restore acid/base balance, treat underlying cause
What is contractility? Pumping strength of the heart
What is stroke volume? Volume ejected by heart in one contraction
What does a narrow curve in dilution indicate? Increased CO
What does a broad curve in dilution indicate? Decreased CO
What is the most accurate measurement of CO? Fick equation
Created by: ashconrad417