Things to know with ICU patients
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| Cardiac Output (CO) | Amount of blood ejected from LV per minute. 4-8L/min. HR x SR
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| Increased CO | High circulating volume
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| Decreased CO | Decrease in the strength of ventricular contraction.
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| Cardiac Index (CI) | Amount of blood pumped by the heart, per minute, per meter square of the body.
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| Decreased CI | Pumping ability of the heart to pump effectively is decreased. Not enough blood being pumped to body.
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| Normal value of CVP | 1-6 mmHg
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| Increased CVP | Right sided HF, Volume overload, Tricuspid valve stenosis or insufficiency, Pulmonary HTN, Cardiac tamponade, Right ventriclar infarction.
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| Decreased CVP | reduced circulating blood volume, vasodilation.
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| Mixed Venous | SvO2 = 60-80%
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| Abnormal Mixed Venous | oxygen supply is not sufficient, oxygen demand has increased.
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| Systemic Vascular Resistance (SVR) | The measurement of resistance or impediment o the systemic vascular bed to blood flow
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| Increased SVR | hypothermia, hypovolemia, vasoconstriction, late septic shock
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| Decreased SVR | vasodilation, early septic shock, morphine, nitrates, hypercarbia
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| Causes of Metabolic Alkalosis | loss of hydrochloric acid from vomiting or gastric suctioning. loss of K (diuretic). steroids. hepatic disease. alkali ingestion (Drano, bleach...)
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| Causes of Metabolic Acidosis | Diarrhea, excessive production of organic acids from endocrine disorders, shock or drug intoxication, inadequate excretion of acid from renal disease
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| Causes of Respiratory Alkalosis | hyperventilation, PE, gram-negative bacteremia, Respiratory stimulation by drugs, disease or fever
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| Causes of Respiratory Acidosis | CNS depression from drugs, injury or disease. Respiratory arrest, Hypoventilation from pulmonary, cardiac or neuromuscular disease.
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| Hypercapnic | give oxygen, increase O2 delivery.
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| Intra-aortic balloon pump (IABP) | decreases myocardial workload. increases coronary artery perfusion.
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| Swan-Ganz catheter | Used to evaluate HF, pulmonary hypertension,
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| Preload | Occurs during DIASTOLE. Think "Volume" Reduce with diuretics. Increase with fluids.
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| Afterload | Think "Vessels" Reduce with (Vasodilators) Nitro, Nipride, ACE, ARBs, Beta Blockers, CCBs, Hydralazine, Isosorbide. Increase with (Vasopressors) Levo, Neo, Epi
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| Contractility | Think "Pump" Increase contractility with Dobutamine, Primacor, Dopamine (high dose).
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| Vasodilators | Nicardipine, NTG, Nitroprusside, Hydralazine, Captopril, Enalaprilat, Losartan (Cozaar)
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| Vasopressors | Dopamine, Epinephrine, Norepinephrine (Levophed), Phenylephrine (Neosynephrine), Vasopressin.
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| Positive Inotropes | Dobutamine (Dobutrex), Milrinone (Primacor), Digoxin (Lanoxin)
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| Beta-Adrenergic Blockers | Metoprolol (Lopressor, Toprol XL), Labetalol, Carvedilol (Coreg)
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| Antiarrhythmics | Amiodarone, Adenosine, Atropine, Esmolol (BB), Diltiazem (CCB), Verapamil (CCB), Digoxin, Lidocaine, Magnesium Sulfate
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| Anticoagulants | Heparin, Lovenox, Coumadin
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| Anti-Platelet Agents | Aspirin, Plavix (Clopidogrel)
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| Measurement of Preload | CVP
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| Measurement of Afterload | SVR
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| Measurement of Contractility | CO/CI
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| Increased Pulmonary Artery Pressure | Left sided heart failure, atrial of ventricular septal defects, (increased pulmonary arteriolar resistance) pulmonary HTN, volume overload, mitral stenosis, hypoxia.
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| Signs of abnormal mixed venous | Increased CO and HR. Tissues take more oxygen from arterial blood. Blood flow redirected to where blood is needed the most.
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| MAP | Reflects relationship between CO and SVR, reflects arterial pressure in the vessels perfusing in organs
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| Low MAP | indicates decreased blood flow through the organs
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| High MAP | indicates an increased cardiac workload
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| PA pressure | BP in the pulmonary artery
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| Increased PA Pressure | Left to Right Cardiac shunt, PH, COPD, Emphysema, PE, Pulm edema, LV failure.
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| Direct Thrombin Inhibitors | Argatroban, Pradaxa
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| S/S of Metabolic Alkalosis | Slow breathing, hypertonic muscles, twitching, confusion, tetany, seizures, dizziness, coma (if severe)
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| S/S of Metabolic Acidosis | Fruity breath, headache, lethargy, n/v, ab pain, tremors, confusion, coma (if severe)
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| S/S of Respiratory Alkalosis | Paresthesias, confusion, light-headedness, anxiety, palpitations.
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| S/S of Respiratory Acidosis | EARLY: Tachycardia, Tachypnea
LATE: bradypnea, confusion, hypotension, lethargy VERY LATE: Coma
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