Emergency Medicine: A Comprehensive Study Guide: Shock

Front 1

SmvO2 is obtained from

Back 1

pulmonary artery catheter, but similar information can be obtained by central venous blood cannulation (ScvO2). ScvO2 correlates well with SmvO2 and can be more easily obtained in the ED setting.

Front 2

SmvO2 is obtained from

Back 2

pulmonary artery catheter, but similar information can be obtained by central venous blood cannulation (ScvO2). ScvO2 correlates well with SmvO2 and can be more easily obtained in the ED setting.

Front 3

= CO × systemic vascular resistance (SVR)].

Back 3

MAP

Front 4

= CO × systemic vascular resistance (SVR)].

Back 4

MAP

Front 5

what should the SaO2 and pCO2 be kept at in shock treatment

Back 5

Mechanical ventilation and sedation decrease the work of breathing and have been shown to improve survival. SaO2 should be restored to greater than 93 percent and ventilation controlled to maintain a PaCO2 35 to 40 mm Hg.

Front 6

what should the SaO2 and pCO2 be kept at in shock treatment

Back 6

Mechanical ventilation and sedation decrease the work of breathing and have been shown to improve survival. SaO2 should be restored to greater than 93 percent and ventilation controlled to maintain a PaCO2 35 to 40 mm Hg.

Front 7

what should the SaO2 and pCO2 be kept at in shock treatment

Back 7

Mechanical ventilation and sedation decrease the work of breathing and have been shown to improve survival. SaO2 should be restored to greater than 93 percent and ventilation controlled to maintain a PaCO2 35 to 40 mm Hg.

Front 8

In the shock patient fluid resuscitation begins with

Back 8

isotonic crystalloid; the amount and rate are determined by an estimate of the hemodynamic abnormality. Most patients in shock have either an absolute or relative volume deficit, except the patient in cardiogenic shock with pulmonary edema. Fluid is given rapidly, in set quantities (e.g., 500 or 1000 mL), with reassessment of the patient after each amount. Patients with modest degree of hypovolemia usually require an initial 20 mL/kg of isotonic crystalloid. More fluids may be necessary with profound volume deficits.

Front 9

In the shock patient fluid resuscitation begins with

Back 9

isotonic crystalloid; the amount and rate are determined by an estimate of the hemodynamic abnormality. Most patients in shock have either an absolute or relative volume deficit, except the patient in cardiogenic shock with pulmonary edema. Fluid is given rapidly, in set quantities (e.g., 500 or 1000 mL), with reassessment of the patient after each amount. Patients with modest degree of hypovolemia usually require an initial 20 mL/kg of isotonic crystalloid. More fluids may be necessary with profound volume deficits.

Front 10

they are most effective when the vascular space is "full" and least effective when the vascular space is depleted.

Back 10

pressors

Front 11

they are most effective when the vascular space is "full" and least effective when the vascular space is depleted.

Back 11

pressors

Front 12

The goal of resuscitation is to maximize survival and minimize morbidity using objective hemodynamic and physiologic values to guide therapy. A goal-directed approach at achieving

Back 12

rine output >0.5 mL/kg per h, CVP 8 to 12 mm Hg, MAP 65 to 90 mm Hg, and ScvO2 >70 percent during ED resuscitation of septic shock significantly decreases mortality.

Front 13

The goal of resuscitation is to maximize survival and minimize morbidity using objective hemodynamic and physiologic values to guide therapy. A goal-directed approach at achieving

Back 13

rine output >0.5 mL/kg per h, CVP 8 to 12 mm Hg, MAP 65 to 90 mm Hg, and ScvO2 >70 percent during ED resuscitation of septic shock significantly decreases mortality.

Front 14

The goal of resuscitation is to maximize survival and minimize morbidity using objective hemodynamic and physiologic values to guide therapy. A goal-directed approach at achieving

Back 14

rine output >0.5 mL/kg per h, CVP 8 to 12 mm Hg, MAP 65 to 90 mm Hg, and ScvO2 >70 percent during ED resuscitation of septic shock significantly decreases mortality.

Front 15

The goal of resuscitation is to maximize survival and minimize morbidity using objective hemodynamic and physiologic values to guide therapy. A goal-directed approach at achieving

Back 15

rine output >0.5 mL/kg per h, CVP 8 to 12 mm Hg, MAP 65 to 90 mm Hg, and ScvO2 >70 percent during ED resuscitation of septic shock significantly decreases mortality.

Front 16

Treatment of a persistently hypotensive patient after maximal therapy can be a harrowing experience. Similar principles apply to both the trauma patient with ongoing hemorrhage and the persistently hypotensive medical patient. Issues to keep in mind include the following:

Back 16

(1) Is the patient appropriately monitored?7 (2) Is there malfunctioning arterial blood pressure monitoring, such as dampening of the arterial line or disconnection from the transducer? (3) Is the patient adequately volume resuscitated? (4) Does the early use of vasopressor falsely elevate CVP and disguise hypovolemia? (5) Is the intravenous tubing into which the vasopressors are running connected appropriately? (6) Are the vasopressor infusion pumps working? (7) Are the vasopressors mixed adequately? (8) Does the patient have a pneumothorax after placement of central venous access? (9) Has the patient been adequately assessed for an occult penetrating injury (a bullet hole or stab wound)? (10) Is there hidden bleeding from a ruptured spleen or ectopic pregnancy? (11) Does the patient have adrenal insufficiency? The incidence of adrenal dysfunction can be as high as 30 percent in this subset of patients.19 (12) Is the patient allergic to the medication just given (e.g., penicillin) or taken before arrival? (13) Is there cardiac tamponade in the chronic renal failure patient on dialysis or cancer patient?

Front 17

Treatment of a persistently hypotensive patient after maximal therapy can be a harrowing experience. Similar principles apply to both the trauma patient with ongoing hemorrhage and the persistently hypotensive medical patient. Issues to keep in mind include the following:

Back 17

(1) Is the patient appropriately monitored?7 (2) Is there malfunctioning arterial blood pressure monitoring, such as dampening of the arterial line or disconnection from the transducer? (3) Is the patient adequately volume resuscitated? (4) Does the early use of vasopressor falsely elevate CVP and disguise hypovolemia? (5) Is the intravenous tubing into which the vasopressors are running connected appropriately? (6) Are the vasopressor infusion pumps working? (7) Are the vasopressors mixed adequately? (8) Does the patient have a pneumothorax after placement of central venous access? (9) Has the patient been adequately assessed for an occult penetrating injury (a bullet hole or stab wound)? (10) Is there hidden bleeding from a ruptured spleen or ectopic pregnancy? (11) Does the patient have adrenal insufficiency? The incidence of adrenal dysfunction can be as high as 30 percent in this subset of patients.19 (12) Is the patient allergic to the medication just given (e.g., penicillin) or taken before arrival? (13) Is there cardiac tamponade in the chronic renal failure patient on dialysis or cancer patient?

Front 18

Treatment of a persistently hypotensive patient after maximal therapy can be a harrowing experience. Similar principles apply to both the trauma patient with ongoing hemorrhage and the persistently hypotensive medical patient. Issues to keep in mind include the following:

Back 18

(1) Is the patient appropriately monitored?7 (2) Is there malfunctioning arterial blood pressure monitoring, such as dampening of the arterial line or disconnection from the transducer? (3) Is the patient adequately volume resuscitated? (4) Does the early use of vasopressor falsely elevate CVP and disguise hypovolemia? (5) Is the intravenous tubing into which the vasopressors are running connected appropriately? (6) Are the vasopressor infusion pumps working? (7) Are the vasopressors mixed adequately? (8) Does the patient have a pneumothorax after placement of central venous access? (9) Has the patient been adequately assessed for an occult penetrating injury (a bullet hole or stab wound)? (10) Is there hidden bleeding from a ruptured spleen or ectopic pregnancy? (11) Does the patient have adrenal insufficiency? The incidence of adrenal dysfunction can be as high as 30 percent in this subset of patients.19 (12) Is the patient allergic to the medication just given (e.g., penicillin) or taken before arrival? (13) Is there cardiac tamponade in the chronic renal failure patient on dialysis or cancer patient?

Front 19

Treatment of a persistently hypotensive patient after maximal therapy can be a harrowing experience. Similar principles apply to both the trauma patient with ongoing hemorrhage and the persistently hypotensive medical patient. Issues to keep in mind include the following:

Back 19

(1) Is the patient appropriately monitored?7 (2) Is there malfunctioning arterial blood pressure monitoring, such as dampening of the arterial line or disconnection from the transducer? (3) Is the patient adequately volume resuscitated? (4) Does the early use of vasopressor falsely elevate CVP and disguise hypovolemia? (5) Is the intravenous tubing into which the vasopressors are running connected appropriately? (6) Are the vasopressor infusion pumps working? (7) Are the vasopressors mixed adequately? (8) Does the patient have a pneumothorax after placement of central venous access? (9) Has the patient been adequately assessed for an occult penetrating injury (a bullet hole or stab wound)? (10) Is there hidden bleeding from a ruptured spleen or ectopic pregnancy? (11) Does the patient have adrenal insufficiency? The incidence of adrenal dysfunction can be as high as 30 percent in this subset of patients.19 (12) Is the patient allergic to the medication just given (e.g., penicillin) or taken before arrival? (13) Is there cardiac tamponade in the chronic renal failure patient on dialysis or cancer patient?

Front 20

Treatment of a persistently hypotensive patient after maximal therapy can be a harrowing experience. Similar principles apply to both the trauma patient with ongoing hemorrhage and the persistently hypotensive medical patient. Issues to keep in mind include the following:

Back 20

(1) Is the patient appropriately monitored?7 (2) Is there malfunctioning arterial blood pressure monitoring, such as dampening of the arterial line or disconnection from the transducer? (3) Is the patient adequately volume resuscitated? (4) Does the early use of vasopressor falsely elevate CVP and disguise hypovolemia? (5) Is the intravenous tubing into which the vasopressors are running connected appropriately? (6) Are the vasopressor infusion pumps working? (7) Are the vasopressors mixed adequately? (8) Does the patient have a pneumothorax after placement of central venous access? (9) Has the patient been adequately assessed for an occult penetrating injury (a bullet hole or stab wound)? (10) Is there hidden bleeding from a ruptured spleen or ectopic pregnancy? (11) Does the patient have adrenal insufficiency? The incidence of adrenal dysfunction can be as high as 30 percent in this subset of patients.19 (12) Is the patient allergic to the medication just given (e.g., penicillin) or taken before arrival? (13) Is there cardiac tamponade in the chronic renal failure patient on dialysis or cancer patient?

Front 21

The bicarbonate deficit is determined by

Back 21

normal HCO3 minus the patient's HCO3) × 0.5 × body weight (kilograms)

Front 22

The bicarbonate deficit is determined by

Back 22

normal HCO3 minus the patient's HCO3) × 0.5 × body weight (kilograms)

Front 23

The bicarbonate deficit is determined by

Back 23

normal HCO3 minus the patient's HCO3) × 0.5 × body weight (kilograms)

Front 24

he normal total circulating volume of an adult is approximately 7 percent of ideal body weight or about

Back 24

5 liters

Front 25

he normal total circulating volume of an adult is approximately 7 percent of ideal body weight or about

Back 25

5 liters

Front 26

he normal total circulating volume of an adult is approximately 7 percent of ideal body weight or about

Back 26

5 liters

Front 27

class I hemorrhage

Back 27

loss of up to 15 percent (about 750 mL) of circulating blood volume

Front 28

class I hemorrhage

Back 28

loss of up to 15 percent (about 750 mL) of circulating blood volume

Front 29

class I hemorrhage

Back 29

loss of up to 15 percent (about 750 mL) of circulating blood volume

Front 30

type II bleed

Back 30

Blood loss of 15 to 30 percent (about 750 to 1500 mL) of total blood volume

Front 31

type II bleed

Back 31

Blood loss of 15 to 30 percent (about 750 to 1500 mL) of total blood volume

Front 32

type II bleed

Back 32

Blood loss of 15 to 30 percent (about 750 to 1500 mL) of total blood volume

Front 33

The blood pressure response ranges from minimal to moderate hypotension as blood loss progresses. Compensatory peripheral vasoconstriction results in skin and pulse changes of decreased perfusion. There may be mild mental status changes. Provided the patient had a normal RBC volume before hemorrhage, this degree of blood loss is tolerated without RBC replacement provided circulating volume is restored.

Back 33

ina type 2 bleed

Front 34

The blood pressure response ranges from minimal to moderate hypotension as blood loss progresses. Compensatory peripheral vasoconstriction results in skin and pulse changes of decreased perfusion. There may be mild mental status changes. Provided the patient had a normal RBC volume before hemorrhage, this degree of blood loss is tolerated without RBC replacement provided circulating volume is restored.

Back 34

in a type 2 bleed

Front 35

The blood pressure response ranges from minimal to moderate hypotension as blood loss progresses. Compensatory peripheral vasoconstriction results in skin and pulse changes of decreased perfusion. There may be mild mental status changes. Provided the patient had a normal RBC volume before hemorrhage, this degree of blood loss is tolerated without RBC replacement provided circulating volume is restored.

Back 35

in a type 2 bleed

Front 36

(class IV hemorrhage)

Back 36

At greater than 40 percent (>2 L) blood loss

Front 37

(class IV hemorrhage)

Back 37

At greater than 40 percent (>2 L) blood loss

Front 38

(class IV hemorrhage)

Back 38

At greater than 40 percent (>2 L) blood loss

Front 39

ratio for isotonic crystalloid volume replacement: for every amount of blood lost

Back 39

3:1 crystalloid solutions are hypo-oncotic because they lack the large protein molecules present in the plasma. This causes a substantial amount of the crystalloid solution administered to shift in to the extravascular space corresponding to the relative size of the intravascular and interstitial fluid compartments

Front 40

ratio for isotonic crystalloid volume replacement: for every amount of blood lost

Back 40

3:1 rystalloid solutions are hypo-oncotic because they lack the large protein molecules present in the plasma. This causes a substantial amount of the crystalloid solution administered to shift in to the extravascular space corresponding to the relative size of the intravascular and interstitial fluid compartments

Front 41

ratio for isotonic crystalloid volume replacement: for every amount of blood lost

Back 41

3:1 rystalloid solutions are hypo-oncotic because they lack the large protein molecules present in the plasma. This causes a substantial amount of the crystalloid solution administered to shift in to the extravascular space corresponding to the relative size of the intravascular and interstitial fluid compartments

Front 42

what are some of the concerns that have been raised about NS and LR

Back 42

The choice of NS versus LR solution has been the focus of controversy over time. However, there is no clear evidence that either of these crystalloid solutions is superior to the other. Concerns have been raised about each fluid: (1) infusion of large volumes of either causes increased neutrophil activation; (2) LR solution also increases cytokine release and may increase lactic acidosis when given in large volumes; and (3) NS exacerbates intracellular potassium depletion and causes hyperchloremic acidosis

Front 43

what are some of the concerns that have been raised about NS and LR

Back 43

The choice of NS versus LR solution has been the focus of controversy over time. However, there is no clear evidence that either of these crystalloid solutions is superior to the other. Concerns have been raised about each fluid: (1) infusion of large volumes of either causes increased neutrophil activation; (2) LR solution also increases cytokine release and may increase lactic acidosis when given in large volumes; and (3) NS exacerbates intracellular potassium depletion and causes hyperchloremic acidosis

Front 44

what are some of the concerns that have been raised about NS and LR

Back 44

The choice of NS versus LR solution has been the focus of controversy over time. However, there is no clear evidence that either of these crystalloid solutions is superior to the other. Concerns have been raised about each fluid: (1) infusion of large volumes of either causes increased neutrophil activation; (2) LR solution also increases cytokine release and may increase lactic acidosis when given in large volumes; and (3) NS exacerbates intracellular potassium depletion and causes hyperchloremic acidosis

Front 45

Using current preservatives, RBCs can be stored for up to

Back 45

42 days and it has been reported that the average age of a unit of blood administered in the United States is approximately 21 days old. Stored RBCs can lose deformability, which can limit their ability to pass normally through capillary beds, or can cause capillary plugging. The oxygen dissociation curve is altered by loss of 2,3-diphosphoglycerate in the erythrocyte, which adversely affects the off-loading of oxygen at the tissue level. Clinical studies report worsening of splanchnic ischemia and an increased incidence of multiple-organ dysfunction associated with transfusion of RBCs that have been stored for longer than 2 weeks.

Front 46

Using current preservatives, RBCs can be stored for up to

Back 46

42 days and it has been reported that the average age of a unit of blood administered in the United States is approximately 21 days old. Stored RBCs can lose deformability, which can limit their ability to pass normally through capillary beds, or can cause capillary plugging. The oxygen dissociation curve is altered by loss of 2,3-diphosphoglycerate in the erythrocyte, which adversely affects the off-loading of oxygen at the tissue level. Clinical studies report worsening of splanchnic ischemia and an increased incidence of multiple-organ dysfunction associated with transfusion of RBCs that have been stored for longer than 2 weeks.

Front 47

Using current preservatives, RBCs can be stored for up to

Back 47

42 days and it has been reported that the average age of a unit of blood administered in the United States is approximately 21 days old. Stored RBCs can lose deformability, which can limit their ability to pass normally through capillary beds, or can cause capillary plugging. The oxygen dissociation curve is altered by loss of 2,3-diphosphoglycerate in the erythrocyte, which adversely affects the off-loading of oxygen at the tissue level. Clinical studies report worsening of splanchnic ischemia and an increased incidence of multiple-organ dysfunction associated with transfusion of RBCs that have been stored for longer than 2 weeks.

Front 48

Central venous pressure response to fluid administration is useful in assessing volume status

Back 48

The principle is that if the CVP does not rise after infusion of a quantity of fluid—typically isotonic crystalloid 250 to 500 mL—then the vascular system is still very compliant (on the flat portion of the pressure-volume compliance curve) and is not "full." If the CVP rises appreciably (>5 to 7 mm Hg) after fluid infusion, then the vascular system has reached the limits of easily distensibility (on the steep portion of the pressure-volume compliance curve) and is therefore "full."

Front 49

Central venous pressure response to fluid administration is useful in assessing volume status

Back 49

The principle is that if the CVP does not rise after infusion of a quantity of fluid—typically isotonic crystalloid 250 to 500 mL—then the vascular system is still very compliant (on the flat portion of the pressure-volume compliance curve) and is not "full." If the CVP rises appreciably (>5 to 7 mm Hg) after fluid infusion, then the vascular system has reached the limits of easily distensibility (on the steep portion of the pressure-volume compliance curve) and is therefore "full."

Front 50

Central venous pressure response to fluid administration is useful in assessing volume status

Back 50

The principle is that if the CVP does not rise after infusion of a quantity of fluid—typically isotonic crystalloid 250 to 500 mL—then the vascular system is still very compliant (on the flat portion of the pressure-volume compliance curve) and is not "full." If the CVP rises appreciably (>5 to 7 mm Hg) after fluid infusion, then the vascular system has reached the limits of easily distensibility (on the steep portion of the pressure-volume compliance curve) and is therefore "full."

Front 51

Central venous pressure response to fluid administration is useful in assessing volume status

Back 51

The principle is that if the CVP does not rise after infusion of a quantity of fluid—typically isotonic crystalloid 250 to 500 mL—then the vascular system is still very compliant (on the flat portion of the pressure-volume compliance curve) and is not "full." If the CVP rises appreciably (>5 to 7 mm Hg) after fluid infusion, then the vascular system has reached the limits of easily distensibility (on the steep portion of the pressure-volume compliance curve) and is therefore "full."

Front 52

Central venous pressure response to fluid administration is useful in assessing volume status

Back 52

The principle is that if the CVP does not rise after infusion of a quantity of fluid—typically isotonic crystalloid 250 to 500 mL—then the vascular system is still very compliant (on the flat portion of the pressure-volume compliance curve) and is not "full." If the CVP rises appreciably (>5 to 7 mm Hg) after fluid infusion, then the vascular system has reached the limits of easily distensibility (on the steep portion of the pressure-volume compliance curve) and is therefore "full."

Front 53

Simultaneous arterial and central venous blood gases allow for the calculation of

Back 53

systemic oxygen extraction ratio (OER, normally about 25 percent). An elevated OER, especially greater than 50 percent, indicates oxygen supply-demand imbalance consistent with global or significant regional hypoperfusion

Front 54

Simultaneous arterial and central venous blood gases allow for the calculation of

Back 54

systemic oxygen extraction ratio (OER, normally about 25 percent). An elevated OER, especially greater than 50 percent, indicates oxygen supply-demand imbalance consistent with global or significant regional hypoperfusion

Front 55

Simultaneous arterial and central venous blood gases allow for the calculation of

Back 55

systemic oxygen extraction ratio (OER, normally about 25 percent). An elevated OER, especially greater than 50 percent, indicates oxygen supply-demand imbalance consistent with global or significant regional hypoperfusion

Front 56

The relatively recent availability of arterial pulse contour analysis catheters allows for

Back 56

continuous cardiac output measurement via an arterial line. This, in addition to central venous oximetry, could prove very helpful in assessing the dynamic changes and adjusting therapy during resuscitation. End-tidal CO2 is predictive of eventual outcome in severely hypoperfused trauma patients, but it is not yet clear how effective this parameter is in assessing patients with lesser degrees of hypoperfusion.

Front 57

The relatively recent availability of arterial pulse contour analysis catheters allows for

Back 57

continuous cardiac output measurement via an arterial line. This, in addition to central venous oximetry, could prove very helpful in assessing the dynamic changes and adjusting therapy during resuscitation. End-tidal CO2 is predictive of eventual outcome in severely hypoperfused trauma patients, but it is not yet clear how effective this parameter is in assessing patients with lesser degrees of hypoperfusion.

Front 58

The relatively recent availability of arterial pulse contour analysis catheters allows for

Back 58

continuous cardiac output measurement via an arterial line. This, in addition to central venous oximetry, could prove very helpful in assessing the dynamic changes and adjusting therapy during resuscitation. End-tidal CO2 is predictive of eventual outcome in severely hypoperfused trauma patients, but it is not yet clear how effective this parameter is in assessing patients with lesser degrees of hypoperfusion.

Front 59

why is Central venous catheterization so great

Back 59

one of the methods of choice for CVP/RAP monitoring. The reason for this popularity relates to its landmarks; it’s short, straight (right IJV), valveless course to the superior vena cava (SVC) and right atrium (RA); and its position at the patient’s head, which provides easy access by anesthetists in more intra operative settings. Further, the success rate for its use exceeds 90% in most series of adults3 and children4

Front 60

why is Central venous catheterization so great

Back 60

one of the methods of choice for CVP/RAP monitoring. The reason for this popularity relates to its landmarks; it’s short, straight (right IJV), valveless course to the superior vena cava (SVC) and right atrium (RA); and its position at the patient’s head, which provides easy access by anesthetists in more intra operative settings. Further, the success rate for its use exceeds 90% in most series of adults3 and children4

Front 61

why is Central venous catheterization so great

Back 61

one of the methods of choice for CVP/RAP monitoring. The reason for this popularity relates to its landmarks; it’s short, straight (right IJV), valveless course to the superior vena cava (SVC) and right atrium (RA); and its position at the patient’s head, which provides easy access by anesthetists in more intra operative settings. Further, the success rate for its use exceeds 90% in most series of adults3 and children4

Front 62

why is Central venous catheterization so great

Back 62

one of the methods of choice for CVP/RAP monitoring. The reason for this popularity relates to its landmarks; it’s short, straight (right IJV), valveless course to the superior vena cava (SVC) and right atrium (RA); and its position at the patient’s head, which provides easy access by anesthetists in more intra operative settings. Further, the success rate for its use exceeds 90% in most series of adults3 and children4

Front 63

whats the risk of a left sided IJ placement

Back 63

. It should be remembered that the thoracic duct lies in close proximity to the left IJV11 and that laceration of the left brachio-cephalic vein or superior vena cava by the catheter is more likely with the left-sided IJV approach to the central circulation. This risk is due to the more acute angle taken by the catheter to enter the superior vena cava form the left side.

Front 64

whats the risk of a left sided IJ placement

Back 64

. It should be remembered that the thoracic duct lies in close proximity to the left IJV11 and that laceration of the left brachio-cephalic vein or superior vena cava by the catheter is more likely with the left-sided IJV approach to the central circulation. This risk is due to the more acute angle taken by the catheter to enter the superior vena cava form the left side.

Front 65

whats the risk of a left sided IJ placement

Back 65

. It should be remembered that the thoracic duct lies in close proximity to the left IJV11 and that laceration of the left brachio-cephalic vein or superior vena cava by the catheter is more likely with the left-sided IJV approach to the central circulation. This risk is due to the more acute angle taken by the catheter to enter the superior vena cava form the left side.

Front 66

whats the risk of a left sided IJ placement

Back 66

. It should be remembered that the thoracic duct lies in close proximity to the left IJV11 and that laceration of the left brachio-cephalic vein or superior vena cava by the catheter is more likely with the left-sided IJV approach to the central circulation. This risk is due to the more acute angle taken by the catheter to enter the superior vena cava form the left side.

Front 67

diagnostic criteria for ARDS include

Back 67

bilateral pulmonary infiltrates, pulmonary artery occlusion pressure (PAOP or "wedge" pressure) below 18 mm Hg, a ratio of arterial to alveolar partial pressure of oxygen less than 0.2, and static airway compliance of less than 40 mL/cm H2O.

Front 68

diagnostic criteria for ARDS include

Back 68

bilateral pulmonary infiltrates, pulmonary artery occlusion pressure (PAOP or "wedge" pressure) below 18 mm Hg, a ratio of arterial to alveolar partial pressure of oxygen less than 0.2, and static airway compliance of less than 40 mL/cm H2O.

Front 69

diagnostic criteria for ARDS include

Back 69

bilateral pulmonary infiltrates, pulmonary artery occlusion pressure (PAOP or "wedge" pressure) below 18 mm Hg, a ratio of arterial to alveolar partial pressure of oxygen less than 0.2, and static airway compliance of less than 40 mL/cm H2O.