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| what is a balloon pump for | Relative support left ventricular function decreases afterload decreases myocardial to consumption increase coronary perfusion promotes pulsatile flow
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| What is the formula for map | Map is systolic plus diastolic times 2 divided by 3
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| the determinants of myocardial perfusion | supply and demand
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| heart rate times stroke volume is the | cardiac output
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| normal cardiac output is | 4 - 6 liters per minute
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| cardiac index = | Cardiac output / BSA
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| normal cardiac index is | 2.5 -3.5 leaders per minute
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| what are the three steps of left ventricular failure | vasoconstriction hypovolemia tissue hypoxia
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| vasoconstriction decreases pumping efficiency by increasing what four things | left ventricular volume and pressure heart rate catecholamine release afterload
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| hypervolemia decreases | cardiac output GFR
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| tissue hypoxia causes | pulmonary edema decreased oxygenation decreased contractility very depressed cardiac output and decreased blood pressure
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| a technique for assisting the circulation in decreasing the work of the Heart by synchronizing the force of an external pumping device with cardiac systole and diastole | counter pulsation
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| primary goal of Intra-aortic balloon therapy is | Increase Supply own inflation decreased demand On deflation
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| The top of the blame should be at the |
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| The top of the Balloon should be at the | 2nd to 3rd intercostal space
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| the bottom of the Balloon should be at the | 5-6 intercostal space
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| on inflation during diastole the balloon does three things | augmentation of diastolic pressure increase coronary perfusion increased myocardial oxygen supply
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| the balloon deflation happens during systole what does it do | decrease afterload decreased cardiac work decreased myocardial oxygen consumption increase cardiac output
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| the inflation happens between what two periods | dicrotic notch and arterial pressure
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| name the contraindications to intra-aortic balloon pump | severe AI abdomen or thoracic aortic aneurysm severe calcified aorta PVD Sheathless insertion with obesity
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| The diameters of the Balloon | 7 French 7.5 French 8 French
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| the maximum length on the pressure tubing is | 8 feet
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| the pressure bag is to be maintained at | 300 mm HG and 3 foot above transducer
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| why is helium used | it's an inert gas decreased density low Reynolds number allow same flow rate for a smaller tubing Less trauma to artery less bleeding and infection less risk of arterial thrombosis
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| what other gas can also be used | CO2
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| what is early inflation | Inflation prior to aortic valve closure
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| Early inflation is indicated by | inflation prior to dicrotic notch
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| Late inflation occurs when | After dicrotic notch
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| Late inflation physiological effect is | Poor coronary perfusion
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| Early deflation during diastole waveform has | Sharp drop after augmentation
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| When in doubt | think inflate late leave (deflate) early
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| The triggers for the pump are | Ecg, pressure, pacer
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| Round tops on iabp wave is | catheter kink
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| Side effects are name 8 | Distal limb ischemia, bleeding, thrombocytopenia, immobility of catheter, infection, aortic dissection, compartment syndrome
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| The 34cc balloon isnused for patients | <5`4
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| The 40cc balloon for pts | 5'4-6'
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| the 50cc pump used for pts height | >6'
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| IFNUNABLE TO INFLATE WITH MACHINE USE | SYRING WITH 400CC OF HELIUM EVERY 5 MINUTES
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| g isovolumetric contraction the pressure int hte aorta and pulmonary arties are ________ thena the pressure in the ventricles. Same higher lower equal | higher
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| THE ATRIOVENTRICULAR VAlves are the | mitral and tricuspid
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| the semilunar valves are the | aortic and pulmonic
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| backward flow of bloof throughthe valve is called | valvular regurgitation
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| a valve severely scarred that its lumen is reduced whilein the open position is called | valvular stenosis
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| virtually all coronary arteries are perfused during | diastole
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| the period of workor the contraction phase of the heart cycle is known as | sytole
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| the period of rest or the relaxationphase of the heart cycle is known as | diastole
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| systole and diastole can be divided into 5 phases | atrial systole, isovolumetric contraction, ventricula ejection, isovolumetric relaxation and ventricular filling
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| the mitral and tricuspids valves are _____ before atrial systole | open
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| the atrial contraction accounts for how much ventricular filling known as preload | 200-30%
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| isovolumetric contraction is the electrical impulse from atria through AV node to ventricula conduction system this is when the ventricles | depolarize and contract
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| after ventriclar contraction occurs ventricular pressure rise abruptly ________ the AV valves | closing
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| isovolumetric means: | same volume
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| the pulmonary valve opens _______ the aortic valve because the pressure gradient is less for the pulmonary circulation | slightly before
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| at the begiining of the cardiac cycle the aortic pressure is at its ________ level | lowest ( diastole)
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| the majority of the blood flow during diastole when the ventricle are at rest, diastolic pressure and time spent in diastole profoundly affect blood flow to the | coronary arteries
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| increase in heart rateis a dcrease in ___________________ perfusion | coroanary artery
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| sheathless insertion may _____ complications of limb ischemia | reduce
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| typical Balloon catheters have _______ lumens. hey are called the | 2, central and gas
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| correct timing inflates the balloon during ________ when the ventricle is relaxed and coronary arteries are filling with blood | diasstole
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| IABP therapy lowers the ______ bp and increases the ______bp | lowers, decreases
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| What else will rise with diastolic augmentation? Workload, systolic BP, Map, workload | Map
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| diastolic augmetation may be though of as _______ because it occurs during diastole | second systole
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| the balloon deflates at the end of | diastole
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| the sudden deflation of the balloon cause a __________ in aortic pressure because the space that was occupied by the balloon is suddenly gone | drop
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| when does the ejection from the left ventricle begin? | when the pressure in the left ventricle is greater tha that in the aorta
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| late deflation of he balloon can worsen | heart failure
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| early deflation can damage the | aortic valve
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| the inflation point should occur at the | diacrotic notch
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| what can the IABP do tp blood platelets? | destroy them
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| the sudden loss of a pulse could signal the occluding of the femoral artery and the CCP should | notify medical control immediately
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| if cardiac arrest occurs the trigger should be set to _______ mode | pressure
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| a minimum of a map of _____ isneccessary to perfuse vital organs during resuscitation | 60
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| he central canal may have ______ visible in it | blood
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| the ______ lumen should never have the presence of blood. if blood is found in this lumen IABP should be | gas, discontinued
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| cause of gas loss alarms include | high fever and significant tachycardia
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| if the console becomes disabled then the balloon should not remain in thepatient for more than | 30 minutes
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| where do you zero a Pa Catheter transducer | patients heart
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| the pcwp is normally around | 45-55cm
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| pulmonary artery pressure is normally | 20-30mmhg systolic
8-15 Diastolic
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| Pulmonary artery wedge pressure should be around | 8-12mmhg
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| PAC catherization can cause | tricuspid regurgitation
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| the red lumen is where the | balloon isinflated
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| yellow lume is the | PA distal lumen
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| the white lumen is for | medication administration
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| the transducer zero area for PA catheter is called the | phlebostatic Axis
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| PICC line most common suite is the | brachial
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| PICClines are indicated for | long term use
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| PICC lines are not idea for | rapid volume resuscitation
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| normal cardiac index pressure is | 2.5 -4 L/min/m2
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| the three determinates of stroke volume are | Preload
Afterload
Contractility
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| preload is determined by | myocardial stretching
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| related to the pressure that the ventricle must generate in order to eject blood into the aorta. Think resistance | afterload
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| sodium Nitroprusside, Nicardipine, Ca2+ Channel blockers, Nitro and beta blockers all cause | afterload reduction
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| propofol hasnegative ________ properties | negative
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| contractility think | inotropes or squeeze
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| Epinephrine, nor epi, dopamine, MIlrinone and Dobutamine are great drugs to increase | contractility
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| hat 2 drugs are good for increased afterload that are vasocnstrictors but not inotropes | Vasopressn and Phenylephrine
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| all inotropes ______ myocardial oxygen consumption | increase
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| High dose catecholimines provide mostly _______ stimulation which leads to vasoconstriction or increased afterload | alpha
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| when inflating the distal balloon pump to o btain a PCWP, the balloon wedges with less than 1ml of air. The CCP knows that the | catheter has advanced too far into the pulmonary circuit
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| pulmonar vascular resistance is measured in | dyne-sec
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| end diastolkic pressure is synomous wit with | preload
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| what is the formula for correcting measured PCWP in a mechanically ventilated patient with PEEP levels aove 10cm/H2o | subtract 1.5 mmhg from the measured PCWP reading for every 5cm H20
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| on Aortic pressure waveform the dicrotic notch represents the | closure of the Aortic valve
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| the balloon at the tip of the PAC holds _____ ml of air | 1.5
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| The Allen test is used to assess | upper extremity perfusion
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| the________ reflects the patients total impedance to blood flow felt by the left ventricle | SVR
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| A thermistor is used for thermodilution to measure | cardiac output
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| Pulmonary artery pressures typically range from ______ systolic to _______ to diastolic | 15 to 30 mmhg to 8-15 mmhg
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| you decide to nflate the balloon of your PAC prior to leaving the referring facility to obtain a PCWP reading. You inject air, but do not see a waveform change indicating a wedge. You are unable to withdraw the air from the balloon. You should suspect tha | balloon has ruptured
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| the tip of a central venous line should reside | just outside of the right atrium
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| if the transducer is moved above the phlebostatic axis, the pressure readings will | decrease
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| all of the following decrease cardiac contractility except hyperkalemia-acidsis, milronone-hypocalcemia | milrinone
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| on arrival at a referrng intensive care unit to transfer a patient with a swanz catheter in place the CCP notes that the first visible marking on the catheter is one thick black line with two thin lines. CCP knows that the cather is inserted to a depth b | 60 and 70
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| mechanical ventilation and or positve end expiratory pressure will | decrease preload
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| when placing a femoral arterial line, the needle should be inserted at a ______ angle | 45 degree
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| the normal value for a CVP reading is | 0-6 mmhg
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| the normal range for a PCWP reading is | 4-12
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| invasive hemodynamic monitoring attempts to assess the physiological condition of which three components of the cardiovascular system | heart, vasicular network, and fluid volume
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| cardiac stroke volume is measured in | L/min
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terry sheffield