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37 Cards in this Set
- Front
- Back
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normal CVP, PAOP, CO (cardiac output), CI (index) SVR, SVR (SVRindex)
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2-6cmh2o
8-12 cmh20 3.8-7.5 L/min 2.4-4.0 L/min 800-1400 dynes/cm 1600-2400 dynes/cm |
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2-6cmh2o
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normal CVP
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8-12 cmh20
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PAOP nl range
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SVR nl rnage
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800-1400 dynes/cm
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CO nl range
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3.8-7.5 L/min
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most commonly used first line agents for volume overloaded patients
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bumetadine, furosemide, torsemide
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2 units of PRBCs increases Hgb by
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25% AND WILL ALSO INCREASE THE CALCULATED O2 delivery by 25%
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general recommendations for blood in trauma victims
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adult trauma victims unresponsive to intial volume expansion with 2L recieve transfusion
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Patients with CHF or CAD should be transfused with the goal of keeping hematocrit above
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hematocrit above 30%
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blood therapy has not been shown to
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improve survival, decrease duration of mechanical ventalation or decrease the need for pressors
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the primary role of norepi is
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in the treatment of septic shock with hypotension attributable to low SVR because it is a predominant alpha-agonist but does have nonselective b activity
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Dopamine has been recommended as the agent of choice in
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cardiogenic shock patients and patients with SBP between 70-90 it activates B-receptors at moderate dose range (3-*mcg/kg/min) and both a and b receptors above 8mcg/kg/min
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the use of epinephrine is limited to what
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because it is a potent alpha and beta agonist roughly 500 times more potent than dopamine and dobutamine, arrhythmogenic its use is limited to cardiac arrest, refractory life threatening bradycardia and anaphylactic shock
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the use of this drug is limited only to failure of electrical cardiac patient
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Isoproterenol
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may be additive in effect to dobutamine
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amrinone and milrinone the phsophodiesterase inhibiter
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activates beta receptors throuhgout its dose range and is a more potent cardiac stimulant than dopamine
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dobutamine
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use of a nonrebreather can provide FiO2 within a range of
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.6-.8
while a venturi can provide .28-.5 |
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all patients who are placed on invasive ventilation should initially recieve
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FiO2 of 1.O because the switch from spontaneous breathing to to assisted ventilation causes unpredictable alterations in pulmonary blood flow and ventilation-perfusion mismatch
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most authors recommend starting PEEP
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at3-5cmH2O
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start peep at 3-5cm H2O and thereafter PEEP is incrementally increased
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by 2-3cmH2O allowing 15-30 minutes after each increase for alveolar recruitment this is increased until SaO2 reaches 88-90 further increases in peep may then be required to limit FiO2 to O.6
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consequences of peep
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increases intrathoracic pressure as this increases a critical point is reached when venous return to the heart is compromised due to increased intrathoracic pressure impairing cardiac output
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how to manage a bradycardic patient without a pulse
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CPR with alternating doses of epi and atropine while preparing initial electrical pacing
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basic principles of electrical pacing
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initial HR set to 80 - 100 BPM in the pulsless patient the output is set at the maximum in contrast to the output set at the minimum in the patient with a pulse in both scenarios the output should be set at 10-20% above the threshold capture
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what are the causes of failure to capture electrical pacing
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hypothermia, hypoglycemia, hypoxemia, acidosis and electrolyte disturbances
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hypovolemic
CVP PAOP SVR CO |
CVP - dc
PAOP - dc SVR - ic CO - dc |
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cardiogenic
CVP PAOP SVR CO |
SBP < 80
CVP - ic PAOP - > 18cmH2O SVR - ic CO - dc CI - < 1.8 |
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Distributive (sps, anaphyl)
CVP PAOP SVR CO |
CVP - dc
PAOP - dc SVR - dc CO - inc (anaphyl) d/i (sepsis) |
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Neurogenic
CVP PAOP SVR CO |
CVP -
PAOP - SVR - dc CO |
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Obstructive
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tamp
CVP - ic PAOP -ic SVR - ic CO - dc |
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the use of O2 delivery devices are required to maintain at least 90% saturation if
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not while delivering 100 percetns then intubation must ensue
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goal MAP in shock is
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70 - 80mmhg
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preload is essentially
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left ventricular end-diastolic wall tension
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MAP is proportional to what product
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SVR and CO therefroe SVR is one of the main determinants of afterload
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suggested cardiac parameters for the diagnosis of cardiogenic shock are
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CI less than 1.8
SBP less than 80 and PAOP greater than 18 addition of a cardiotonic vasopressor is required |
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Intra Aortic Baloon pump should be considered in patients who do not respond to pressor s in cardiogenic shock
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Intra Aortic Baloon pump should be considered in patients who do not respond to pressor s in cardiogenic shock
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vasoactive agent of choice in sepsis
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norepi initally SVR is elevated but then decreases
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most sensible agent for neurogenic shock
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norepi or neosynephrine
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