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2brt hemodynamic

hemodynamic monitoring

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
Created by: laura2brt