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What does a Swan-Ganz/pulmonary artery catheter measure?
Measures CVP, PAP, PCWP; allows for aspiration of mixed venous blood from pulmonary artery- best determinant of tissue oxygenation/O2 consumption
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Troubleshooting: arterial line transducer is above the level of the heart, what happens to the pressure reading?
Pressure reading will read lower than actual pressure
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Troubleshooting: arterial line transducer is below the level of the heart, what happens to the pressure reading?
Pressure reading will be higher than actual pressure
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What is the dicrotic notch on the arterial waveform?
Closing of aortic valve; if not visible, the pressure is most likely inaccurate
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What does cardiopulmonary stress testing (CPET) measure?
Ability of heart and lungs during exercise, O2 consumption and CO2 production
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What does exercise stress testing measure?
Cardiopulmonary reserve capacity
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What does indirect calorimetry measure?
Energy expenditure by measurement of VCO2 and VO2; helps assess metabolic state and nutritional needs
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Normal respiratory quotient (RQ)
0.80-0.85
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Normal VO2 (O2 consumption)
150-275 mL/min
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What does PVR measure?
Afterload of right ventricle
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What does SVR measure?
Resistance that the left ventricle must overcome to eject its volume of blood AKA preload
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What causes increased intrapulmonary shunting?
PNA, PTX, pulmonary edema, ATX
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Decreased C(a-v)O2
Decreased QT/CO
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Increased C(a-v)O2
Increased QT/CO, septic shock, anemia
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CaO2 equation
- CaO2 = (1.34 x Hb x SaO2) + (PaO2 x 0.003)
- CaO2 = O2 bound to Hb + O2 dissolved in plasma
- *Replace with SvO2 and PvO2 for venous content
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Thermodilution technique
Measure of QT (CO) through the pulmonary artery catheter, uses Fick equation
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PCWP>18 mmHg indicates..
Cardiogenic pulmonary edema
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PCWP measures..
Left atrium pressure, left ventricular end-diastolic pressure
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What reflects tissue oxygenation?
PvO2
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Where is mixed venous blood sampled from?
Pulmonary artery
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CVP measures..
Right atrial pressure, systemic venous return, right ventricular preload
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Where is PCWP measured?
Distal branch of pulmonary artery
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Treatment for third-degree heart block
Pacemaker
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Third-degree heart block looks like..
No determinable PR interval
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Treatment for second-degree heart block
Isoproterenol, atropine, pacemaker
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Second-degree heart block looks like..
QRS complex is preceded by two to four P waves
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Treatment for first-degree heart block
Atropine, isoproterenol
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First-degree heart block looks like..
PR interval longer than 0.20 sec
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Treatment for V-fib
Defibrillation, CPR
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Treatment for V-tach
Lidocaine, defibrillation, CPR
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Treatment for A-fib
Cardioversion, propranolol, digitalis
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Bigeminy
Every other beat is a PVC- dangerous arrhythmia
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Treatment for atrial flutter
Cardioversion, carotid artery massage, procainamide, digitalis, tranquilizers
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PVC on ECG looks like..
QRS complex is abnormal and wider than 0.12 sec
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Treatment for PVC
If more than 6 PVCs per minute, use lidocaine, procainamide, propranolol
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Treatment for PAC
If more than 6 PACs per minute, use lidocaine
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Inconsistent R to R intervals on ECG represent..
Sinus arrthythmia
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Treatment for sinus tachycardia
Stop underlying cause, digitalis, beta blockers
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Treatment for sinus bradycardia
Atropine, pacemaker
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Normal QRS complex
0.06-0.12 sec
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Normal PR interval
0.12-0.20 sec
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Prolonged PR interval on ECG represents..
First or second degree heart block
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Abnormal ST segment on ECG represents..
Cardiac ischemia; sign of coronary artery disease
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Inverted T wave on ECG represents..
Presence of coronary artery disease
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Widened QRS on ECG represents..
Right bundle-branch block and PVCs
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QRS complex on ECG represents..
Ventricular depolarization/contraction
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P wave on ECG represents..
Atrial depolarization/contraction
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