Hemodynamics

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Basic Hemodynamic Monitoring.

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  • 1) May Be Invaluable In Diagnosing And Managing Patients. 2) Requires Critical Care Knowledge And Skill. 3) Noninvasive Hemodynamic Monitoring Is Available.
  • To evaluate the hemodynamic response to fluid therapy, medication and other treatments Aspiration of air emboli
  • Standard Swan-Ganz (7.0F) VIP Swan-Ganz (7.5 F) SVO 2 Monitoring Swan-Ganz (8.0F) Pacing Swan-Ganz Monitoring (Interventional) Swan-Ganz
  • Components: 1. Proximal port – approximately 30 cm from tip of catheter. Also known as the CVP port (central venous pressure). It lies in the right atrium and measures CVP. It can be used for infusion of IV solutions or medications, for drawing blood and for injecting cardiac output boluses. It is usually color coded blue. 2. Distal port – opening is at the tip (end) of the catheter. A lso known as the PA port. It lies directly in the pulmonary artery and measures the pulmonary artery pressures (PAP), systolic (PAS), and diastolic (PAD). It also measures the pulmonary capillary wedge pressure (PCWP) when the balloon is inflated. The PA pressures should always be monitored continuously . NEVER USE the PA port for medication infusion. It c an be used for drawing "mixed venous" blood gas samples. It is u sually color coded yellow. 3. Thermistor and connector port T he thermistor connector connects the pulmonary catheter to the cardiac output computer. The connector is at the end of a separate catheter lumen outside the patient thermistor wire. Blood temperature is transmitted within the lumen (the core temperature is the most accurate reflection of the body temperature). It is used in determining cardiac output. The connector tip should always have a protective covering to protect patient from microshock. It is usually color coded yellow with a red connector. 4. Balloon port The balloon port is located < 1 cm from the tip of the catheter. When the balloon is inflated with approximately 0.8 to 1.5 cc of air, the catheter will become lodged (wedged) in the pulmonary artery and gives a wedge tracing. It r eflects the pressures that are in the left side of the heart when inflated. DO NOT INFLATE WITH LIQUID---- ALWAYS INFLATE WITH AIR. When deflated, turn stopcock to off position and leave syringe connect to the port. It is usually color coded red. 5. A 5 - lumen Swan Ganz catheter has either an infusion port or a pacing port A pacing port allows for insertion of a transvenous pacing wire. The infusion port allows for infusion of IV solutions or medications. It is usually color coded white.
  • 1 ) Jugular, Subclavian, Superior Vena Cava And Right Atrial Pressures Essentially Equal Because Of No Valve Between Them. 2) Balloon Is Inflated In The Right Atria. 3) Balloon Must Be Inflated To Advance. 4) Balloon Must Be Deflated To Withdraw.
  • 1) If RV Irritated… May Cause Ventricular Dysrhythmias, Including VT. 2) Must Immediately Move Catheter If Ectopy In RV. 3) Catheter May Migrate Back Into RV.
  • 1) Dicrotic Notch Represents Pulmonary Valve Closure. 2) Watch For Changes In Waveforms And Pressures (PAD).
  • 1) Wedging Can Cause Pulmonary Artery Rupture. 2) Prolonged Wedging Can Cause Ischemia To The Lung Tissue Distal to The Catheter. 3) Prolonged Wedging Can Cause Injury To The Pulmonary Artery. 4) Normal PA = 15-25/8-15 And Normal PAWP = 6-12. 5) Watch For Changes In Waveforms And Pressures. 6) PAWP = PACP = PCWP = PAOP = Wedge. PAWP is the most accurate reflection of left atrial pressure, therefore of left ventricular end-diastolic pressure (LVEDP), or preload.
  • 1) Normal Pressures: RA = 1-7 RV = 15-25/1-7 PA = 15-25/8-15 PAD = 8-15 PAWP = 6-12
  • Every one to four hours: a. Verify alarm limits are on and appropriate. b. Assess adequate fluid level in pressure bag. c. Ensure pressure bag is inflated to 300 mm Hg. Microrate infusion devices will be used on hemodynamic lines for all pediatric patients who weigh less than 20 Kg and for patients with severe fluid restrictions, i.e. ARF. d. Obtain for all hemodynamic monitoring lines: pressure readings at the phlebostatic axis level Obtain for PA catheters only: 1. cardiac output, cardiac index, systemic vascular resistance and pulmonary vascular resistance unless otherwise ordered 2. pulmonary capillary wedge pressure readings, unless otherwise ordered 3. SVO 2 readings 4. continuous cardiac output readings Every eight to twelve hours and prn: a. Zero and level all pressure transducers. b. Obtain: 1. pressure waveform tracings and readings from each line. 2. occlusion cuff pressure for arterial lines. c. For pulmonary artery catheter, ensure catheter sleeve not taped. d. For pulmonary artery catheter, check catheter length at insertion site.
  • Even though there may be a small effect of PEEP on intravascular pressure measurements, it is not advisable to eliminate (turn off) PEEP temporarily while pressure measurements are being made, as this may induce hemodynamic instability due to changes in venous return and PO2. These measurements off PEEP will therefore not accurately reflect the patient's hemodynamic status when PEEP is being used.
  • Even though there may be a small effect of PEEP on intravascular pressure measurements, it is not advisable to eliminate (turn off) PEEP temporarily while pressure measurements are being made, as this may induce hemodynamic instability due to changes in venous return and PO2. These measurements off PEEP will therefore not accurately reflect the patient's hemodynamic status when PEEP is being used.
  • PAWP
  • a wave Rise in pressure due to atrial contraction. a waves are larger in the presence of any resistance to RV filling, (tricuspid stenosis, RV failure, cardiac tamponade) because resistance will increase pressure as the atrium attempts to contract and eject blood. x descent Fall in pressure due to atrial relaxation. c wave Rise in pressure due to ventricular contraction and bulging of the closed tricuspid valve. v wave Rise in pressure during atrial filling. y descent Fall in pressure due to the opening of the tricuspid valve and the beginning of ventricular filling.
  • a wave Rise in pressure due to atrial contraction. a waves are larger in the presence of any resistance to RV filling, (tricuspid stenosis, RV failure, cardiac tamponade) because resistance will increase pressure as the atrium attempts to contract and eject blood. x descent Fall in pressure due to atrial relaxation. c wave Rise in pressure due to ventricular contraction and bulging of the closed tricuspid valve. v wave Rise in pressure during atrial filling. y descent Fall in pressure due to the opening of the tricuspid valve and the beginning of ventricular filling.
  • a wave = atrial contraction Large a waves will be seen with anything that increases pressure during atrial contraction, such as mitral stenosis, an ischemic LV, or an LV in failure which is not emptying completely v wave = atrial filling Large v waves will be present with any resistance to ventricular filling such as mitral regurgitation, volume overload, cardiac tamponade
  • Timing of the pulmonary artery waveforms: An A wave follows the QRS wave on ECG, whereas V wave follows the T wave on ECG.
  • The fall in venous pressure following opening of the A-V valve is termed the y descent .
  • a waves atrial contraction large a waves will be seen with anything that increases pressure during atrial contraction, such as mitral stenosis, an ischemic LV, or an LV in failure which is not emptying completely v waves atrial filling large v waves will be present with any resistance to ventricular filling such as mitral regurgitation, volume overload, cardiac tamponade  
  • 1 = a wave (approx. 40mmHg) 2= v wave (approx. 52mmHg) 3= steep V descent Simultaneous recording of EKG helps identify v wave in mitral vale regurgitation, v wave corresponds to t wave of EKG. Large V waves are not always indicative of Mitral insufficiency. The size of the V wave depends on both the volume of blood entering the atrium during ventricular systole and left atrial compliance. Decreased left ventricular compliance may result in prominent V wave
  • Continuous SVO2 monitoring allows the minute-to-minute assessment of total tissue oxygen balance ( i.e. , the relationship between oxygen delivery and oxygen consumption). SVO2 varies directly with cardiac output, Hb, and SaO2, and inversely with VO2 (oxygen consumption.). The normal SVO2 is 75%, which indicates that under normal conditions, tissues extract 25% of the oxygen delivered. An increase in VO2 or a decrease in arterial oxygen content (SaO2 x Hb) is compensated by increasing CO or tissue oxygen extraction. When the SVO2 is less than 30%, tissue oxygen balance is compromised, and anaerobic metabolism ensues. A normal SVO2 does not ensure a normal metabolic state but suggests that oxygen kinetics are either normal or compensated.
  • Bleeding Infection Dysrhythmias Pulmonary Artery Rupture Pneumothorax Hemothorax Valvular Damage Embolization Balloon Rupture Catheter Migration
  • Pulsus Paradoxus = paradoxical pulse = abnormally large inspiratory fall in arterial pressure (10mmHg or more) When left ventricular SV is decreased, blood pools in the lung and right side or the heart during inspiration, increasing intrapericardial pressure.
  • Occlusion
  • Measurement of the mixed venous oxygen saturation, or the saturation of blood in the pulmonary artery, can be continuous with special PA catheters. This blood is normally unoxygenated, having not yet traveled through the lungs, with a saturation of 60-80%. SvO 2 is clinically important as a function of supply and demand; how much oxygen is being extracted from the blood by the organs, before this blood is returned to the right heart. SvO 2 , therefore, serves us in evaluating the supply and demand of oxygen to the tissues. It is influenced by oxygen delivery (hemoglobin, SaO 2 , cardiac output) as well as oxygen consumption.
  • 1) Beta Blockers 2) Beta Adrenergics 3) Calcium Channel Blockers 4) Epinephrine 5) Dopamine 6) Lasix 7) Bumex 8) Edecrin 9) NTG 10) Nipride 11) Neo-Synephrine 12) Levophed 13) Dobutamine 14) Dopamine 15) Primacor
  • 1) Cardiac Tamponade =  PA Pressures,  SVR  CO, CI, and BP. 2) Left Ventricular Failure =  PAWP RVSW Normal 3) Right Ventricular Failure =  RA/CVP,  RV Pressure  RVSW 4) PA Hypertension =  PA Pressures,  PVR May Lead To Cor Pulmonale 5) Endotoxins And Histamines Produce Vasodilation =  SVR.
  • 1) Normal Values: CVP = 1-7 mmHg PAWP = 6-12 mmHg CO = 4.0-8.0 L/Min. CI = 2.5-4.0 L/Min. SVR = 700=1500 dynes/sec/cm 5 PVR = 100-250 dynes/sec/cm 5 RVSW = 10-15 gm 2 /beat LVSW = 60-80 gm 2 /beat
  • CVP Example
  • CVP Answer
  • Example 1
  • Answer 1
  • Example 2
  • Answer 2
  • Example 3
  • Answer 3
  • Example 4
  • Answer 4
  • Example 5
  • Answer 5
  • Example 6
  • Answer 6
  • Hemodynamics

    1. 1. HEMODYNAMICS In the CRITICAL CARE UNIT Sherry L. Knowles, RN, CCRN, CRNI
    2. 2. DEFINITION PURPOSE DEFINITION HEMODYNAMIC MONITORING <ul><ul><li>Measuring and monitoring the factors that influence the force and flow of blood. </li></ul></ul><ul><ul><li>To aid in diagnosing, monitoring and managing critically ill patients. </li></ul></ul>
    3. 3. OBJECTIVES <ul><li>Define Basic Hemodynamics </li></ul><ul><li>Understand The Risks and Benefits </li></ul><ul><li>Identify PA Catheter Components </li></ul><ul><li>Analyze Cardiac Profiles </li></ul><ul><li>Interpret Shock States </li></ul><ul><li>Learn Appropriate Interventions </li></ul><ul><li>Describe How To Optimize Cardiac Output </li></ul><ul><li>Recognize Potential Complications </li></ul>Upon completion of this program the student will be able to:
    4. 4. OBJECTIVES <ul><li>Collect appropriate equipment/supplies necessary to set-up a transducer pressure system. </li></ul><ul><li>State the correct solutions/medications used at Kaiser Vallejo for the flush bags. </li></ul><ul><li>Correctly level and zero the transducer. </li></ul><ul><li>Correctly identify the location and purpose of each port/ lumen of the PA catheter </li></ul><ul><li>Identify in sequence the normal waveforms observed during PA catheter insertion, and state the corresponding pressure. </li></ul><ul><li>Correctly obtain the following pressures: </li></ul><ul><ul><ul><li>Pulmonary artery systolic, diastolic and mean </li></ul></ul></ul><ul><ul><ul><li>Pulmonary capillary wedge. </li></ul></ul></ul><ul><ul><ul><li>Central venous pressure. </li></ul></ul></ul><ul><li>Briefly describe the indications, limitations and complications of PA catheterization, guidelines for accurate monitoring, and troubleshooting. </li></ul>Upon completion of this program the student will be able to:
    5. 5. INDICATIONS <ul><li>To diagnose shock states </li></ul><ul><li>To determine fluid volume status </li></ul><ul><li>To measure cardiac output </li></ul><ul><li>To monitor and manage unstable patients </li></ul><ul><li>To assess hemodynamic response to therapies </li></ul><ul><li>To diagnose primary pulmonary hypertension, valvular disease, intracardiac shunts, cardiac tamponade, and pulmonary embolus </li></ul>
    6. 6. CONTRAINDICATIONS <ul><li>Tricuspid or pulmonary valve </li></ul><ul><li>mechanical prosthesis </li></ul><ul><li>Right heart mass </li></ul><ul><li>(thrombus and/or tumor) </li></ul><ul><li>Tricuspid or pulmonary </li></ul><ul><li>valve endocarditis </li></ul>
    7. 7. SWAN-GANZ CATHETERS <ul><li>The Cordis Offers A Large Bore Infusion Port </li></ul><ul><li>There Are Ten Types Of Swan-Ganz Catheters </li></ul><ul><li>VIP Catheter Has Three Other Infusion Ports </li></ul><ul><li>Large Markers = 50cm, Small Markers = 10cm </li></ul>
    8. 8. SWAN GANZ CATHETER
    9. 9. SWAN GANZ COMPONENTS
    10. 10. SWAN GANZ PLACEMENT
    11. 11. SWAN GANZ PLACEMENT
    12. 12. <ul><li>Bleeding </li></ul><ul><li>Infection </li></ul><ul><li>Dysrhythmias </li></ul><ul><li>Pulmonary Artery Rupture </li></ul><ul><li>Pneumothorax </li></ul><ul><li>Hemothorax </li></ul><ul><li>Valvular Damage </li></ul><ul><li>Embolization </li></ul><ul><li>Balloon Rupture </li></ul><ul><li>Catheter Migration </li></ul>RISKS WITH SWAN GANZ
    13. 13. INSERTION EQUIPMENT <ul><li>EQUIPMENT NECESSARY FOR INSERTION </li></ul><ul><li>Flush solution for transducer system </li></ul><ul><li>Flush solution for cardiac output system </li></ul><ul><li>Arterial access line </li></ul><ul><li>Disposable triple pressure transducer system </li></ul><ul><li>Pulmonary artery catheter                                </li></ul><ul><li>Monitor, module, electrodes, cables </li></ul><ul><li>Central line kit                            </li></ul><ul><li>Transducer holder, I.V. pole, pressure bag </li></ul><ul><li>Emergency resuscitation equipment     </li></ul><ul><li>Prepackaged Introducer Kit; sutures </li></ul><ul><li>Sterile gowns, gloves, and masks </li></ul>
    14. 14. RA WAVEFORM <ul><li>Normal Value 0-8 mmHg </li></ul><ul><li>RAP = CVP </li></ul><ul><li>Wave Fluctuations Due To Contractions </li></ul>
    15. 15. RV WAVEFORM <ul><li>Normal Value 15-25/0-8 mmHg </li></ul><ul><li>Catheter In RV May Cause Ventricular Ectopy </li></ul><ul><li>Swan Tip May Drift From PA to RV </li></ul>
    16. 16. PA WAVEFORM <ul><li>Normal Value 15-25/8-15 mmHg </li></ul><ul><li>Dicrotic Notch Represents PV Closure </li></ul><ul><li>PAD Approximates PAWP (LVEDP) (in absence of lung or MV disease) </li></ul>
    17. 17. PAWP WAVEFORM <ul><li>Normal Value 8-12 mmHg </li></ul><ul><li>Balloon Floats and Wedges in Pulmonary Artery </li></ul><ul><li>PAWP = LAP = LVEDP </li></ul><ul><li>Wedging Can Cause Capillary Rupture </li></ul>
    18. 18. PA INSERTION WAVEFORMS <ul><li>A = RA (CVP) Waveform </li></ul><ul><li>B = RV Waveform </li></ul><ul><li>C = PA Waveform </li></ul><ul><li>D = PAWP Waveform </li></ul>B C D A
    19. 19. PA CATHETER WAVEFORMS A wave - due to atrial contraction. Absent in atrial fibrillation. Enlarged in tricuspid stenosis, pulmonary stenosis and pulmonary hypertension. C wave - due to bulging of tricuspid valve into the right atrium or possibly transmitted pulsations from the carotid artery. X descent - due to atrial relaxation. V wave - due to the rise in atrial pressure before the tricuspid valve opens. Enlarged in tricuspid regurgitation. Y descent - due to atrial emptying as blood enters the ventricle. Canon waves - large waves not corresponding to a, v or c waves. Due to complete heart block or junctional arrhythmias.
    20. 20. PA INSERTION SEQUENCE
    21. 21. POST INSERTION <ul><li>Assess ECG for dysrhythmias. </li></ul><ul><li>Assess for signs and symptoms of respiratory distress. </li></ul><ul><li>Ascertain sterile dressing is in place. </li></ul><ul><li>Obtain PCXR to check placement. </li></ul><ul><li>Zero and level transducer(s) at the phlebostatic axis. </li></ul><ul><li>Assess quality of waveforms (i.e., proper configuration, dampening, catheter whip). </li></ul><ul><li>Obtain opening pressures and wave form tracings for each waveform. </li></ul><ul><li>Assess length at insertion site. </li></ul><ul><li>Ensure that all open ends of stopcocks are covered with sterile dead-end caps (red dead-end caps, injection caps, or male Luer lock caps). </li></ul><ul><li>Update physician of abnormalities. </li></ul>
    22. 22. ZEROING & REFERENCING <ul><li>Zeroing is performed by opening the system to air to establish atmospheric pressure as zero. </li></ul><ul><li>Referencing is accomplished by placing the air-fluid interface of the catheter (the transducer) at the phlebostatic axis. </li></ul>
    23. 23. PHLEBOSTATIC AXIS
    24. 24. RESPIRATORY VARIATION <ul><li>Intrathoracic pressure  decreases during spontaneous inspiration  </li></ul><ul><li>This presents a negative (  ) deflection on a PAWP tracing </li></ul><ul><li>Intrathoracic pressure  increases during spontaneous expiration  </li></ul><ul><li>This present a positive (  ) deflection on a PAWP tracing </li></ul>SPONTANUOUS VENTILATION :
    25. 25. RESPIRATORY VARIATION <ul><li>Intrathoracic pressure  increases during positive pressure ventilation (ventilator breaths) </li></ul><ul><li>This presents a positive (  ) deflection on a PAWP tracing </li></ul><ul><li>Intrathoracic pressure  decreases during positive pressure expiration </li></ul><ul><li>This present a negative (  ) deflection on a PAWP tracing </li></ul>POSITIVE PRESSURE VENTILATION :
    26. 26. RESPIRATORY VARIATION Spontaneous Breathing
    27. 27. RESPIRATORY VARIATION
    28. 28. END EXPIRATION
    29. 29. RAP WAVEFORM RAP WAVEFORM
    30. 30. (CVP) RA WAVEFORM & ECG
    31. 31. (CVP) RA WAVEFORM (CVP) RA WAVEFORM
    32. 32. WEDGING THE CATHETER
    33. 33. PAWP TRACING PAWP WAVEFORM
    34. 34. PAWP WAVEFORM PAWP WAVEFORM
    35. 35. PA vs PAWP WAVEFORM PA vs PAWP WAVEFORM
    36. 36. PAWP WAVEFORM & ECG PAWP WAVEFORM
    37. 37. PAWP WAVEFORM PAWP WAVEFORM
    38. 38. V WAVES PAWP WAVEFORM
    39. 39. PAWP WITH V WAVES
    40. 40. SVO 2 MONITORING
    41. 41. SVO2 MONITORING <ul><li>Normal Values: 60-75% </li></ul><ul><li>Decreased (  ) SVO 2 Values Indicate </li></ul><ul><li> Increased  Extraction </li></ul><ul><li> From Decreased Oxygen Delivery </li></ul><ul><li> or </li></ul><ul><li> From Increased Oxygen Demands </li></ul>
    42. 42. POTENTIAL COMPLICATIONS POTENTIAL COMPLICATIONS Same as arterial pressure monitoring plus the following: Air emboli Cardiac tamponade Thromboembolism Dysrhythmias Catheter displacement Balloon rupture Infection Lung ischemia Inaccurate pressures Electromicroshock Equipment malfunction Pulmonary artery rupture Pneumothorax/Hemothorax Frank Hemorrhage Loss of balloon integrity Altered skin integrity Pulmonary artery extravasation PA hemorrhage or infarction Air emboli Cardiac arrest
    43. 43. <ul><li>Wedging Can Cause Capillary Rupture </li></ul><ul><li>Catheter In RV Can Cause Ventricular Ectopy </li></ul><ul><li>Swan Tip Can Drift From PA to RV </li></ul>POTENTIAL COMPLICATIONS
    44. 44. PERICARDIAL TAMPONADE <ul><li>Hemodynamic monitoring can diagnose tamponade: </li></ul><ul><li>Pericardial tamponade presents with equalization of the diastolic pressures on the left and right side of the heart </li></ul><ul><li>Other PAP signs of pericardial tamponade include: </li></ul><ul><ul><li>Elevated right atrial pressure </li></ul></ul><ul><ul><li>Kussmaul sign (increase in right atrial pressure with inspiration) </li></ul></ul><ul><ul><li>Pulsus Paradoxus </li></ul></ul><ul><ul><li>Elevated right atrial pressure (RAP) </li></ul></ul><ul><ul><li>Pulmonary artery diastolic pressure (PAD) = mean right atrial pressure(RA) = right ventricular (RV) diastolic pressure = mean wedge pressure </li></ul></ul>
    45. 45. PRECAUTIONS <ul><li>Always set alarms, approximately 20 mmHg above and below the patient’s readings. </li></ul><ul><li>If balloon is down and you find PA catheter tracing in wedge position, you may ask the patient to deep breathe and cough, or reposition patient in bed to dislodge it. </li></ul><ul><li>If unable to dislodge catheter from wedge position by above measures notify physician immediately to reposition catheter by pulling back gently; then, get chest x-ray to confirm proper placement. </li></ul><ul><li>If patient coughs up blood or it is suctioned via endotracheal tube, suspect PA rupture and notify physician immediately. </li></ul>
    46. 46. TROUBLESHOOTING
    47. 47. <ul><li>= 0-8 mm Hg </li></ul><ul><li>= 15-25 / 8-15 mm Hg </li></ul><ul><li>= 8-12 mm Hg </li></ul><ul><li>= 8-12mm Hg </li></ul><ul><li>= 50-100 ml/beat </li></ul><ul><li>= 4-8 L/min </li></ul><ul><li>= 2.5-4.0 L/min M 2 </li></ul><ul><li>= 0.60-0.75 </li></ul>NORMAL VALUES <ul><li>Right Atrial Pressure (CVP) </li></ul><ul><li>Pulmonary Artery Pressure </li></ul><ul><li>Pulmonary Artery Wedge Pressure </li></ul><ul><li>Left Ventricular Diastolic Pressure </li></ul><ul><li>Stroke Volume </li></ul><ul><li>Cardiac Output </li></ul><ul><li>Cardiac Index </li></ul><ul><li>SVO 2 </li></ul>
    48. 48. DAMPENED PA WAVEFORM PAWP WAVEFORM
    49. 49. ALTERATIONS IN SVO 2
    50. 50. ALTERATIONS IN SVO 2
    51. 51. <ul><li>Optimize HR and SV (Stroke Volume) </li></ul><ul><li>Stroke Volume = </li></ul><ul><li>PRELOAD </li></ul><ul><li>AFTERLOAD </li></ul><ul><li>CONTRACTILITY </li></ul><ul><li>Chronotropic Medications </li></ul><ul><li>Diuretics / Volume </li></ul><ul><li>Vasodilators / Vasoconstrictors </li></ul><ul><li>Inotropic Medications (Positive or Negative) </li></ul><ul><li>IABP </li></ul>OPTIMIZING CARDIAC OUTPUT
    52. 52. <ul><li>Shock States </li></ul><ul><ul><li>Cardiogenic Shock </li></ul></ul><ul><ul><li>Hypovolemic Shock </li></ul></ul><ul><ul><li>Septic Shock </li></ul></ul><ul><ul><li>Anaphylactic Shock </li></ul></ul><ul><li>Cardiac Tamponade </li></ul><ul><li>Left Ventricular Failure </li></ul><ul><li>Right Ventricular Failure </li></ul><ul><li>Pulmonary Hypertension </li></ul>CARDIAC PROFILES
    53. 53. SHOCK PARAMETERS <ul><ul><ul><li>Cardiogenic Shock is the only shock with  PAWP. </li></ul></ul></ul><ul><ul><ul><li>Early (Hyperdynamic) Shock is the only shock with  CO and  SVR. </li></ul></ul></ul><ul><ul><ul><li>Neurogenic Shock is the only shock with  bradycardia. </li></ul></ul></ul><ul><ul><ul><li>Anaphylactic Shock has the definitive characteristic of wheezing due to bronchospasm. </li></ul></ul></ul>
    54. 54. TREATMENTS
    55. 55. SAMPLE MEASUREMENTS
    56. 56. MEASUREMENTS
    57. 57. SAMPLE MEASUREMENTS
    58. 58. SAMPLE MEASUREMENTS
    59. 59. SAMPLE MEASUREMENTS
    60. 60. SAMPLE MEASUREMENTS
    61. 61. SAMPLE MEASUREMENTS
    62. 62. SAMPLE MEASUREMENTS
    63. 63. SAMPLE MEASUREMENTS
    64. 64. SAMPLE MEASUREMENTS
    65. 65. SAMPLE MEASUREMENTS
    66. 66. SAMPLE MEASUREMENTS
    67. 67. SAMPLE MEASUREMENTS
    68. 68. SAMPLE MEASUREMENTS
    69. 69. SAMPLE MEASUREMENTS
    70. 70. SAMPLE MEASUREMENTS
    71. 71. <ul><li>Hemodynamic monitoring measures factors that influence the force and flow of blood. </li></ul><ul><li>Hemodynamic monitoring aids in diagnosing, monitoring and managing critically ill patients. </li></ul>SUMMARY
    72. 72. THE END
    73. 73. REFERENCES <ul><li>AACN (American Association of Critical Care Nurses). Clinical Care References. 2002 </li></ul><ul><li>SCCM (Society of Critical Care Medicine. PACEP (Pulmonary Artery Catheter Education Project). 701 Lee Street, Suite 200, Des Plaines, Illinoise 60016. 2000. </li></ul><ul><li>Bridges, EJ, and Woods, SL. Pulmonary artery pressure measurement: State of the art. Heart Lung 1993; 22:99. </li></ul><ul><li>Mirini, JJ. Pulmonary artery occlusion pressure: Clinical physiology, measurement and interpretation. Am Rev Respir Dis 1983; 128:319. </li></ul><ul><li>Putterman, C. The Swan-Ganz catheter: A decade of hemodynamic monitoring. J Crit Care 1989; 4:127. </li></ul><ul><li>Nemens, EJ, Woods, SL. Normal Fluctuations in pulmonary artery and pulmonary capillary wedge pressures in acutely ill patients. Heart Lung 1982; 11:393. </li></ul><ul><li>Darovic, G.O., (1995) H emodynamic monitoring: invasive and noninvasive clinical application (2d ed), New York: W. B. Saunders </li></ul>

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