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113 Cards in this Set
- Front
- Back
what is contractility
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strength of vent contraction
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force or energy of contraction
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inotropic
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what is chronotropic
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rate of contraction
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measurement of pressure, flow, volume, and oxygenation within the CV system
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hemodynamics monitoring
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volume of blood within ventricle at end of diastole
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preload
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what is preload AKA
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stretching
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things that decrease preload (4)
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heart dys
hypovolemia dehydration systemic vasodilation (pooling) |
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what is left vent preload reflected by
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PCWP
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what is right vent preload reflected by
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CVP
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afterload AKA
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resistance
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forces opposing ventricular ejection
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afterload
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amount of blood ejected by the vents with contaction
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stoke volume
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what is cardiac output
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hr x sv
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determined by HR and rhythm, preload, afterload, contractility
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cardiac output
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what is cardiac index
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CO adjusted for BSA
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how to zero pressure lines
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open stopcock to air
hit zero function on the mtr and digital returns zero |
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when should the lines be zeroed
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during initial set up of art line
STAT after insertion |
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what is 0
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atmospheric pressure
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where is the transducer placed to zero the line
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phlebostatic axis
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what does positioning the transducer allow for
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measurement to be taken
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what is phlebostatic axis
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middle chest at 4th intercostal space
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what pressure does a central line show
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preload pressure
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what are pressure bags set at for hemodynamics monitoring
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300mmhg
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how much does the flusher deliver.hr
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3ml/hr
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if the pressure shows green in window what does it mean
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correct pressure
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when are pressure bags used
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art lines
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reflects the amt of fluid returning to the r side of the heart (preload)
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CVP
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PA/swan themodilation cath can mtr what pressures (2)
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pulomary artery pressure
PAWP |
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PA/swan can mtr what pressures
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SVR
PVR |
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how can CVP be obtained
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transducing central line
attach h20 filled column to line proximal lumen of swan/pa line |
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cvp reflects what
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r atrial filling (preload)
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PAp reflects what
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l atrial preload
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PAWP reflects what
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l atrial pressure -
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PVR reflects what
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resistance of the pulmonary bed
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SVR reflects what
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resistance of the vascular bed (afterload)
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normal MAP
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70-105mmhg
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normal Co
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4-8L/min
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normal SVR
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800-1200 dynes/sec/cm
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normal PVR
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<250 dynes/sec/cm
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normal PAWP
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6-12 mmhg
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normal PA
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15-25/ 8-15
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normal CVP
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2-8 mmhg
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sites to mtr CVP
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r jugular
subclavian antecubital |
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what can affect the CVP measurements (2)
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spontaneous breathing
positive pressure vent |
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what does spont breathing do to CVP
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decreases
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what does neg and pos pressure vent do to CVP
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neg- decreases
pos-increases |
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blocking of arterial flow causes what
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ischemia to tissues
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reasons for art pressure mtr
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HTN/hypo
resp failure/shock use of vasopressors freq ABGs |
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what should be done if blood gets in transducer
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change the line
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causes of art pattern dampening (4)
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clot in line
blood backup in line catheter tip against vessel wall air/bubble in line |
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dicrotic notch
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closin of the valve
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difference in art line and cuff pressure
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art is 5-10 mm hg higher
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what should be done if bp cuff and art line pressures are diff (3)
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make sure line is zeroed to air
insure proper cuff size check for hypotension |
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what does elevation of the PA waveform mean
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overinflation
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distal tip of PA catheter sits where
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pulmonary art pressure
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if distal tip of cath is inflated what does it show
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PAWP
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indicators of cardiac function and fluid volume status (2)
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PA DIASTOLIC PRESSURE
AND PAWP |
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how long can balloon be inflated
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8-15 sec (4 resp cycles)
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mls of inflation that are acceptable
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1-1.5mls
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if too much inflation occurs what could happen
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tissue damage/pop it
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proximal tip of cath
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superior vena cava
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red port of swans ganz
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balloon
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tells how fast and how much CO
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swans ganz
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decrease in PAWP mean....
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fluid volume deficit
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increase in PAWP means....
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fluid overload
L vent failure |
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increase PA pressure and PAWP
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L sided heart failure
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increases PA and normal PAWP
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pulmonary disease
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decrease PA pressure
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low volume
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wedge pressure shows what
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L vent function
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characteristics of CVP (4)
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right atrial
proximal port reflects preload blood sampling |
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right vent and reflects preload of L side
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PAP
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reflects L vent pressure
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PAWP
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afterload- resistance to blood flow in body
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SVR
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used to clamp off to IV fluids and pull of specimen to dilute then draw blood
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VAMP
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decreased PAWP means
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FVD
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increased PAWP
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fluid overload
L vent failure |
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allows visualization on the waveforms during insertion of SWan
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transducer
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results in decreased SVR (3)
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vasodilation
shock states drugs that decrease afterload (nipride) |
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results in increased SVR (3)
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vasoconstriction
hypovolemia vasoactive agents |
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complications with PA/swan cath (5)
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infection
sepsis air embolus vent ddysrhy pulm infarction |
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done to prevent infection in cath every 96hrs
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change flush bag
pressure tubing transducer stopcock |
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what should be done if PA cath cannot be wedged
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repositioning
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causes of pulm infarction or PA rupture (4)
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balloon rupture
prolonged inflation spont wedging thrombus/embolus formation |
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how to prevent PA rupture/ pulm infarction (3)
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never inflate beyond capacity
use 1-1.5 ml of air check PA waveforms often |
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what should PA waveforms be checked often for (3)
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occlusion
dislocation spont wedging |
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what are the 3 components of the skull
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brain tissue
blood cerebrospinal fluid |
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what happens if the components of the skull change
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pressure changes
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causes changes in ICP (2)
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occlusion
overproduction of CSF |
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changes in blood (7)
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stroke
hematoma trauma BP CO increased flow increased pressure |
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causes tissue changes (2)
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edema
tumor |
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what happens if transducer is left open to atmosphere
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free flow of blood
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what must all stopcocks have
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deadenders
luer locks |
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should always be monitored with hemodynamics
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trends
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CPP < 50 means...
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no perfusion to cells
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what is CPP
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pressure needed to ensure blood flow to the brain
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MAP-ICP
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=CPP
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normal CPP
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70-100
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what is CPP <50 associated with (2)
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ischemia
neuronal death |
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high ICP =
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no delivery of 02 and blood to cells
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what happens if ICP increases
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then pressure delivering blood increases also
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where can ICP be measured (4)
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ventricles (common)
subarachnoid space epidural space brain parenchymal tissue |
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normal ICp
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0 -15mmhg
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where should transducer be placed when monitoring ICp
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tragus of ear bc its level with vents
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how can ICP be controlled with catheter
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by removing CSF
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how should ICP be measured
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as a mean pressure at the end of expiration
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what is a serious concern when monitoring ICp
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infection
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what are the waveforms of ICP similar to
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arterial pressure trace
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what can cause inaccurate ICP readings (5)
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CSF leaks
obstruction in cath differences in ht of bolt/tranducer kinks in tubing incorrect height of drainage system |
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optimal level of CPP
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60 or above
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can help drive the MAP (2)
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vasopressors
fluids |
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helps minimize ICp (3)
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sedation
osmotic agents (3%NS) ventriculostomy |
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what does 3%NS do
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pulls fluid into blood stream to increase MAP and decrease ICp
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dose for dopamine
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<3mcg/kg/min
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