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66 Cards in this Set
- Front
- Back
What is the formula for MAP?
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2/3 DBP + 1/3 SBP
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What is the formula for BP?
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CO x SVR
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What is the formula for CO?
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SV x HR
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What is the definition of preload?
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how much blood is going to the left ventricle (LV)
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What is left ventricular end diastolic volume (LVEDV)?
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volume right before systole reflects how much blood is going to be pumped out of the heart
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What can be used to estimate LVEDV?
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pulmonary capillary wedge pressure (PCWP)
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What is the definition of afterload?
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resistance of the LV
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What is used to estimate afterload?
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SVR
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What is the formula for cardiac index (CI)?
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CO/BSA
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What does a central venous catheter (CVC) measure?
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BP and fluid status
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What is a pulmonary arterial catheter useful for? (4)
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1)volume status
2)volume performance 3)estimating O2 delivery and uptake 4)differentiating shock syndromes |
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What complications can be caused w/ the use of a pulmonary arterial catheter?
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1)premature atrial or ventricular contractions
2)pulmonary artery rupture |
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CO normal value
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4.7L/min
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CI normal value
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2.8-4.5 L/min/m2
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SV normal value
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60-100 mL
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SVR normal value
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900-1400 dynes*sec/cm5
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PCWP normal value
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6-15 mmHg
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CVP normal value
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2-6 mmHg
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MAP normal value
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80-100 mmHg
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CI <2.2 means what?
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hypoperfusion
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PCWP >18 means what?
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pulmonary edema
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CI<2.2 AND PCWP >18 means what?
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cardiogenic shock
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CI<2.2 AND PCWP <18 means what?
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hypovolemic shock
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What are the pharmacologic goals for hemodynamic monitoring?
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1)increase tissue perfusion
a)increase MAP >65mmHg b)increase in CO 2)normalization of oxidative metabolism a)return of aerobic metabolism |
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Examples of crystalloids
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1)NS
2)LR |
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What are the advantages of crystalloids?
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1)low cost
2)widely available |
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What are the disadvantages of crystalloids?
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1)only 25-33% remian in intravascular space
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Examples of colloids?
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1)albumin 5%
2)hetastarch 6% |
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What are the advantages of colloids?
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1)range from 80-100% remain in intravascular space
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What are the disadvantages of colloids?
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1)very expensive
2)may not be readily available |
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What are the treatment goals of managing hemodynamic instability?
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1)maintain adequate circulation for tissue perfusion
a)MAP> 60-65 mmHg b)SBP > 90 mmHg c)CI > 2.2 L/min/m2 d)normal HR (<90bpm) e)adequate UO (>0.5-1mL/kg/hr) |
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Physiological and hemodynamic effects of receptors: alpha1
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1)arterial and venous vasoconstriction
2)increase SVR, increase MAP |
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beta1
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1)increase contractility, chronotropy
2)increase CO, increase HR |
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beta2
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1)arterial and venous vasodilation
2)decrease SVR |
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DA
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1)vasodilation
2)insignificant increase in UO |
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VP
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1)vasoconstriction, fluid retention, increase cortisol
2)increase SVR, increase MAP |
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What are pharmacological agents classified as vasopressors? (5)
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1)dopamine
2)norepinephrine 3)epinephrine 4)phenylephrine 5)vasopressin |
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What are pharmacological agents classifed as inotropes? (4)
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1)dopamine
2)dobutamine 3)milrinone 4)levosimendan |
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What are the effects of DA dose 0.5-3mcg/kg/min?
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1)increase renal and mesenteric blood flow
2)inhibition of proximal tubule Na+ reabsorption |
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What are the effects of DA dose 3-10mcg/kg/min?
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1)stimulation of beta receptors
a)increase CO, HR, contractility |
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What are the effects of DA dose 10-20mcg/kg/min?
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1)stimulation of alpha1 receptors
a)increase in SVR, MAP |
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Dopamine adverse effects (5)
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1)tachyarrhythmias
2)increase MVO2 3)peripheral ischemia 4)increase afterload and preload 5)pulmonary congestion |
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What receptors does norepinephrine act on?
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1)stimulation of alpha1 receptors
-increase peripheral vasoconstriction => increase SVR 2)No effect on beta receptors -increase inotropy, chronotropy -smaller extent than a1 effects |
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What is the effect of pH on norepinephrine?
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decrease activity in acidosis (need to increase dose)
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norepinehrine dosing
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2-50mcg/min titrated to MAP >65mHg
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What are the adverse effects of norepinephrine? (4)
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1)increase afterload
2)peripheral ischemia 3)increase MVO2 4)cardiac arrhythmias |
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What receptors does phenylephrine have an effect on?
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1)stimulation of alpha1 receptors
-increase in peripheral vasoconstriction 2)no effect on beta receptors |
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phenylephrine dosing
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30-300mcg/min (max 200mcg/min) titrated to MAP >65mmHg
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phenylephrine adverse effects (6)
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1)increase afterload
2)peripheral ischemia 3)myocardial ischemia 4)reflex bradycardia 5)peripheral bradycardia 6)hypertension |
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What receptors does epinephrine act on?
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1)stimulation of alpha1 receptors
-increase peripheral vasoconstriction 2)stimulation of beta receptors -increase in inotropy, chronotropy -increase in peripheral vasodilation |
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epinephrine dosing
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1)0.01-0.05mcg/kg/min
-beta1,2 -increase SVR, MAP???? 2)>0.05mcg/kg/min -alpha1, beta1 -increase in CO, HR, contractility??? |
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What are the side effects of epinephrine? (4)
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1)increase MVO2
2)tachyarrhythmias 3)ischemia 4)lactic acidosis |
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What receptors does vasopressin act on?
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1)stimulation of VP1
-peripheral vascoconstriction 2)stimulation of VP2 -sodium and water retention -decrease UO 3)stimulation of VP3 -increase ACTH and cortisol production |
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Indication for vasopressin
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adjunct to other vasopressors in septic shock
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Benefits of vasopressin along with other vasopressors
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decrease dose of other vasopressors
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Vasopressin dosing
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0.01-0.04units/min
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What are the side effects of vasopressin? (2)
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1)decrease CO
2)myocardial and splanchnic ischemia |
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Inotrope pharmacology
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-stimulation of beta receptor converts AMP -> cAMP which activates PKa which releases Ca++ from sarcoplasmic reticulum which binds to Tnc
-phosphodiesterase inhibitors inhibit cAMP -> AMP |
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What receptors does dobutamine act on?
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1)stimulation of beta receptors
-increase inotropy and chronotropy -small increase in peripheral vasodilation 2)stimulation of alpha1 -increase peripheral vasoconstriction -to a MUCH SMALLER EXTENT than beta effects |
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dobutamine dosing
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2.5mcg/kg/min (max 20) titrated to desired CI
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what are the adverse effects of dobutamine? (3)
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1)increase MVO2
2)ventricular arrhythmias 3)hypotension |
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Milrinone MOA
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1)phosphodiesterase type 3 inhibitor
-inhibit breakdown of cAMP in myocardium and vasculature -increase contractility and peripheral vasodilation |
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milrinone bolus dose (optional)
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50mcg/kg/IV over 10min
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milrinone infusion dosing
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0.25-0.75mcg/kg/min
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milrinone dosing for renal adjustment
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0.2-0.43mcg/kg/min base on CrCl
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milrinone adverse effects (5)
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1)ventricular arrhythmias
2)hypotension 3)reflex tachycardia 4)thrombocytopenia 5)headache |