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PT3: L2
Hemodynamics
| Question | Answer |
|---|---|
| What is the general definition of shock? | -Inadequate perfusion of critical organs -Final pathway leading to CV failure and death -Hypovolemic shock is the leading cause of early death after trauma |
| What are the most accurate monitoring parameters of blood pressure (SBP vs MAP, numeric targets) when non-invasive or invasive techniques are used? | Non-invasive (SBP most accurate) 90 - 120 Invasive (MAP most accurate) 70 – 105 (Target is > 60-65) |
| What are four potential etiologies of hypotension? | -Hypovolemia: Not enough blood volume -Cardiac failure: Bad pump -Obstruction: Decreased preload and increased afterload -Distributive: Low SVR |
| Memorize the hemodynamic equations describing blood pressure, cardiac output, mean arterial pressure and systemic vascular resistance. | BP = CO * SVR CO = SV * HR BP = SV * HR * SVR SVR = [(MAP-CVP)/CO] * 80 |
| The normal adult ranges for: -CO: -CI: -MVOS: -SVR: -PVR: -PAWP: -CVP (know the targets for critically ill patients) | -CO: 4-8 L/min -CI: 2.8-3.6 L/min/m^2 -MVOS: 60-80% -SVR: 800-1200 dyne*sec/cm^5 -PVR: 60-120 (<250 is goal) -PAWP: 6-12 mmHg -CVP (know the targets for critically ill patients): 2-6 mmHg (Targets: Hypo <6 mmHg; Normo 6-14 mmHg; Hyper >14 mmHg) |
| How is Right and Left Heart Measured? | -Right Heart: Preload: CVP/RAP Output: CO/CI Afterload: PVR -Left Heart Preload: PAWP Output: CO/CI and SvO2 Afterload: SVR |
| Understand the Frank-Starling curve. | Sarcomere Length increases, Stroke volume SHOULD increase for normal heart function. Less increase in Stroke volume, higher level of heart failure |
| What effect does systemic vascular resistance have on stroke volume? | Inversely proportional to afterload. (SVR is measurement of afterload) SV has to do with CO. |
| Understand concepts illustrated in the “flow diagram” of the different types of shock | All lead to an eventual drop in MAP, which is caused by ^ in SVR and a v in CO. (Except for Distributive shock where SVR decreases.) |
| Hypovolemic Shock | CO: decreased PAWP/CVP: WAY decreased SVR: Increased SVO2: Decreased Tx: Volume Resuscitation |
| Cardiogenic Shock | CO: WAY Decreased PAWP/CVP: Increased SVR: Increased SvO2: Decreased Tx: Inotropes, afterload reducers, diuretics |
| Obstructive Shock | CO: WAY Decreased PAWP/CVP: Increased/Same SVR: Increased SvO2: Decreased Tx: Lyses of embolism, Inotropes |
| Distributive Shock | CO: Increased/Same PAWP/CVP: Same SVR: WAY Decreased SvO2: Increased Tx: Volume repletion and/or systemic vasoconstrictors and/or inotropes |
Created by:
Nami01
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