Interpretation. Hemodynamic Monitoring Interpretation. Is easy! Don t work to make it hard!!! hemo = dynamic = hemodynamic = Interpretation

Transcription

1 Hemodynamic Monitoring 2 Is easy! Don t work to make it hard!!! 3 hemo = dynamic = hemodynamic = 1

2 4 Circulation occurs because of blood pressure! Hemodynamics = 5 Without enough BP, tissues will not receive needed oxygen & nutrients However, high BP strains the heart & will eventually cause heart failure 6 If BP " # If BP $# Arterial BP can change w/o affecting venous BP so must measure all BP s 2

3 7 Heart Pump that creates pressure gradient Changes in the heart itself will directly affect BP: "HR or strength of contraction # $ HR or strength of contraction # 8 Blood Amount of fluid in circulatory system affects BP: "blood volume # $ blood volume # 9 Vessels Tone of the blood vessels affect BP: vasoconstriction # vasodilation # 3

4 10 We can manipulate all 3 factors that control BP HR, contractility (epinephrine, Dopamine) Blood volume (diuretics) Vessel tone (epinephrine, Nitroprusside, Dopamine) Changes in hemodynamic measurements will reveal which of the 3 has been altered 11 Rule of 4 s Heart has 4 chambers Each chamber serves 1 of the 4 circulatory branches: LV - RA - RV - LA - 12 Each chamber & connecting artery or venous system has its own BP - 4 pressures LV - systemic arteries - RA - systemic veins - RV - pulmonary arteries - LA - pulmonary veins - Hemodynamics measures each of these pressures 4

5 13 Leave capillaries In capillaries Enter capillaries Must be the same from both ventricles 2. Normally % 3. If not: HR 100/min HR 100/min RVSV 70 ml RVSV 70 ml LVSV 69.9 ml LVSV 69.9 ml = 7.0 lpm x 60 min = liters = 7.0 lpm x 60 min = liters = 6.99 lpm x 60 min = liters = 6.99 lpm x 60 min = liters.6 L. = 600 ml.6 L. = 600 ml Where is that 600 ml? 15 CVP = RAP = RVEDP = RV preload Measures pressure in the systemic venous system Much lower than mean ABP Since most of blood is in the venous system, changes in the CVP reflect changes in vascular volume.... 5

6 16 CVP used to monitor vascular fluid levels & right heart function Treat when - Transducer at level of RA 17 Condition CVP PAP PCWP Q T RV Failure " (N) $ (N) $ (N) $ Hypervolemia " " " " Hypovolemia $ $ $ $ 18 Measures blood moving through the pulmonary arteries into the lungs Increases in PAP occur in lung disease/" PVR 6

7 19 Condition CVP PAP PCWP Q T Lung Problems " " (N) $ (N) $ COPD Pulmonary emboli ARDS (Pulm. edema) Pneumonia Hypervolemia " " " " Hypovolemia $ $ $ $ 20 = PWP = PAOP % LAP % LVEDP % LV preload When BTFDC wedged - no longer measures forward flow of blood Measures back pressure from pulm. veins which are in direct communication with left heart 21 PCWP monitors left heart (LV & mitral valve)! Treat when - 7

8 22 Condition CVP PAP PCWP Q T Left Heart Problems LV failure Mitral valve stenosis Cardiogenic pulm. edema High PEEP " " " (N) $ >12 mmhg >18 mmhg Hypervolemia Hypovolemia " $ " $ " $ " $ 23 Condition CVP PAP PCWP Q T Right heart " (N) $ (N) $ (N) $ Lung Problems " " (N) $ (N) $ Left heart " " " $ Hypervolemia " " " " Hypovolemia $ $ $ $ 24 " PAP + normal PCWP = " PAP + " PCWP = 8

9 25 PAd - PCWP: 26 PCWP cannot be > 27 Preload = Afterload =. BTFDC tip should lie in a Zone III artery Q T $ # O 2 extraction " # PvO 2, SvO 2 $ _ # C(a-v)O 2 " _ SvO 2 is best indicator of tissue oxygenation 9

10 28 56 yof, post-op chole, MVS 1500 hrs 1700 hrs 1900 hrs BP (mmhg) 128/ /90 100/60 CVP (cmh 2 O) HR yom PAP 40/26 mmhg PCWP 18 mmhg CVP. 10 cmh 2 O Q T 3.4 lpm kg. male PAP 53/34 mmhg PCWP 28 mmhg CVP 10.6 cmh 2 O _ C(a-v)O vol% 10

11 31 ICU patient PAP 26/8 mmhg PA mean 15 mmhg PCWP. 28 mmhg Q T 6.0 lpm yof PAP 52/30 mmhg PCWP 10 mmhg CVP. 12 mmhg Q T 3.9 lpm kg. patient PAP 43/21 mmhg PCWP 3 mmhg CVP 12 cmh 2 O. Q T 3.9 lpm _ C(a-v)O vol% 11

12 34 Which of the following disorders is known to cause the PCWP to become elevated? a. ARDS b. LVF c. RVF d. hypervolemia e. increased PVR 35 Data of 70 kg. patient in ICU: Which of the following drugs would the RCP be least likely PAP 53/39 mmhg to recommend? PCWP. 32 mmhg Q T 3.4 lpm a. Dopamine _ C(a-v)O vol% b. morphine sulfate Temp c. oxygen d. propanolol (Inderol) e. furosemide (Lasix) 36 Data of 70 kg. patient in ICU: Which of the following is most likely to be responsible for this PAP 60/38 mmhg patient s elevated PCWP? PCWP. 26 mmhg Q T 11.7 lpm a. hypervolemia _ C(a-v)O vol% b. hypovolemia. VO ml/min c. LVF d. ARDS e. RVF 12

13 37 Data of 70 kg. patient in ICU: Which of the following assessments regarding this PAP 22/6 mmhg patient is true? PCWP _ 2 mmhg C(a-v)O vol% a. Patient is hypovolemic. Temp. 37 b. LVF exists.. c. The Q T is decreased. d. Pulm. edema is inevitable. 38 RCP is monitoring a patient in ICU: Which of the following is the most appropriate assessment? PAP 23/7 mmhg PCWP 26 mmhg a. Data is in error PA mean 16 mmhg b. LV dysfunction exists Q T 10.6 lpm c. PVR is increased d. Patient is hypovolemic e. Normal study 39 Data of 50 kg. patient in ICU: Which of the following is(are) true statements? CVP 10 mmhg PAP 43/21 mmhg a. LVF exists. PCWP 2 mmhg b. Patient is hypovolemic. Q T 2.9 lpm c. CV reserves are excellent. C(a-v)O vol% d. PVR is increased. VO ml/min 13

14 40 28 yof, 4 days post- Fx femur: Which of the following is most likely responsible? RR 40/min PAP 44/27 mmhg a. LVF exists. PCWP 6 mmhg b. Patient is hypervolemic. Q T 5 lpm c. Pulm. emboli are present. BP 85/50 mmhg d. PVR is increased. 41 Data of 70 kg. patient in ICU: Which of the following mechanisms is(are) responsible PCWP 36 mmhg for the low Q T? Q T 3.1 lpm C(a-v)O vol% a. RVF VO ml/min b. LVF c. hypovolemia d. increased PVR e. ARDS 42 Data of 70 kg. patient in ICU: Which of the following mechanisms is(are) responsible PCWP 3 mmhg for the low Q T? Q T 3.1 lpm C(a-v)O vol% a. RVF VO ml/min b. LVF c. hypovolemia d. ARDS 14

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