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Hemo Final Exam
| Question | Answer |
|---|---|
| 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
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