Comprehensive presentation on intra arterial blood pressure with a good insight into the the basic physics and brief look into the risks and complications.
Go through the cybercrimes which are occuring recently
Hacking devices are a new method of killing people.
Technologies have been so much advanced.
How to be safe from this?
Go through my works then. :)
Be aware.. Your parents are being treated with devices while treatment.. be sure to know the cybersecurity features of it.
Portable devices (Insulin pumps etc) are also in threat.
Comprehensive presentation on intra arterial blood pressure with a good insight into the the basic physics and brief look into the risks and complications.
Go through the cybercrimes which are occuring recently
Hacking devices are a new method of killing people.
Technologies have been so much advanced.
How to be safe from this?
Go through my works then. :)
Be aware.. Your parents are being treated with devices while treatment.. be sure to know the cybersecurity features of it.
Portable devices (Insulin pumps etc) are also in threat.
This is a very simple presentation prepared for nurses. It will help nurses to understand the need of monitoring and the available methods. The presentation has been constructed on a clinical case base scenario and gradually different methods of monitoring has been introduced.
This is a very simple presentation prepared for nurses. It will help nurses to understand the need of monitoring and the available methods. The presentation has been constructed on a clinical case base scenario and gradually different methods of monitoring has been introduced.
central venous pressure and intra-arterial blood pressure monitoring. invasiv...prateek gupta
central venous pressure and intra-arterial blood pressure monitoring. various sites for cvp and Ibp insertion. working principle for cvp and ibp. indication and complication. various waveform of cvp and ibp
A 30-minute talk, presented as part of the weekly teaching activities in Alder Hey Children's Hospital (Liverpool, UK). It addresses PDA evaluation in children - starting with embryology & anatomy with the basis behind physiological closure versus patency after birth. What is the role of echo study in diagnosing/evaluating PDA? Modes used with some clear movies? Its limitations?
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
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2. Agenda
Arterial line
Central venous line
Swan Ganz catheters
Periocardiocentesis
Intraaortic balloon counterpulsation
Bedside temporary pacemakers
www.cardiozag.com
3. WHAT IS AN ARTERIAL LINE?
An arterial line is a cannula
usually positioned in a
peripheral artery
Such as:
Radial artery
Brachial artery
Dorsalis pedis artery
Femoral artery
www.cardiozag.com
4. INDICATIONS FOR USING
ARTERIAL LINE
Ease of access
Continuous monitoring of arterial
blood pressure
• if patient is on intropic drugs
• if patient is on vasoactive drug
• if patient requires frequent arterial
blood sampling
www.cardiozag.com
7. THE ARTERIAL WAVEFORM
The arterial waveform
reflects the pressure
generated in the arteries
following ventricular
contraction and can be
described as having:-
• Anacrotic notch
• Peak systolic pressure
• Dicrotic notch
• Diastolic pressure
www.cardiozag.com
9. CVP
Reasons For Inserting Central
Venous Catheters
Limited vascular access
Administration of intropes , highly osmotic or
caustic fluids or medications
Frequent administration of blood and blood products
Frequent blood sampling
Measurement of CVP
Hemodialysis
www.cardiozag.com
10. COMMON CENTRAL LINE
INSERTION SITES
Right internal jugular
left internal jugular
right subclavian
left subclavian
femoral (as a last
resort)
Or peripherally
inserted central
catheters (PICC)
which are inserted
via the antecubital
veins (basilic vein is
the best) in the arm
and is advanced into
the central veins
www.cardiozag.com
17. INTERPRETATION
• An increase of above normal (up to 10 cm H2O) may
indicate weakening or failure of the
right side of the heart, or excessive
intravascular volume
• A pressure below 5cm H2O usually
reflects an intravascular volume deficit
or drug induced excessive vasodilation
• CVP measurements must not be
interpreted on their own, but viewed
alongside the patient's full clinical
picture
(BP, Respiratory Pattern, Colour, Temperature)
• Several measurements are required
to identify a trend www.cardiozag.com
20. What is a Swan?
Full name: Swan-Ganz
Catheter
Pulmonary Artery (PA)
Catheter = right heart catheter
Used it to monitor a patient’s
hemodynamics when we cant
answer the question using
noninvasive/clinical measures
Useful to measure right atrial,
pulmonary artery, right
ventricular pressures and
indirectly measure left atrial
pressures, cardiac output and
systemic vascular resistance
www.cardiozag.com
21. Why use a Swan?
Differentiation between causes of shock>cardiogenic,
hypovolemic, septic
Differentiation between causes of pulmonary
edema>cardiogenic versus noncardiogenic
Diagnosis of pericardial tamponade
Diagnosis of intracardiac shunt
Evaluation/Management of pulmonary hypertension
Diagnosis of lymphangitic spread of tumor and fat
embolism
Management of complicated MI, HF
Determine need for vasopressor/inotropic therapy
Fluid Status>in GI bleed, renal failure, sepsis
Ventilator management>determining the best PEEP
www.cardiozag.com
22. Escape Trial
The value of Swan-Ganz catheterization to
guide tailored therapy in heart failure patients
is an area of controversy.
The randomized ESCAPE trial showed no
benefit on a primary end point of the number
of days alive and out of the hospital at six
months
JAMA. 2005;294:1625-1633. www.cardiozag.com
23. Insertion Techniques
Goal: get the catheter to the pulmonary
artery
Right internal jugular vein or left
subclavian allows easiest passage
Swan should be oriented ex-vivo to
approximate the course in the body
Catheter goes through an introducer and
into the vein. The balloon stays closed until
we reach the right atrium.
When we reach the right atrium (20cm),
balloon should be inflated to reduce
possibility of injury to the myocardium.
Then the balloon should be moved quickly
through the right ventricle (30cm)> and
then pulmonary artery (40cm) and PCWP
(50cm) FROM SUBCLAVIAN/IJ
APPROACH
www.cardiozag.com
24. How do you know you are in the Right
Atrium?>>20 cm
Normal right atrial presssure is 0-6mmHg.
Normal oxygen content 15%
Normal O2 saturation 75%
www.cardiozag.com
25. What Elevates the Right Atrial Pressure?
RV infarct
Pulmonary hypertension
Pulmonary stenosis
Left to right shunt
Tricuspid valvular disease
Left heart failure
www.cardiozag.com
26. How do you know you are in the right ventricle?
RV systolic=17-30
RV diastolic=0-6
RV O2 content=15%
RV O2 saturation 75%
30cm
www.cardiozag.com
28. How do you know you are in the pulmonary artery?
Normal PA pressure,
systolic 15-30
Normal PA pressure,
diastolic 5-13
O2 content 15%
O2 saturation 75%
29. What Elevates PA pressure?
Volume Overload (backflow)
Primary lung disease
Primary pulmonary hypertension
Pulmonary Embolism
Left to right shunt
Mitral Valve Disease
www.cardiozag.com
30. THE WEDGE:
What is the Pulmonary Artery Wedge Pressure?
The measurement is obtained when the inflated balloon impacts into a slightly
smaller branch of the pulmonary artery. This is where the arterial pressure exceeds
the venous pressure and the venous pressure exceeds the alveolar pressure, thereby
creating a continuous column of blood from the catheter tip to the left atrium
when the balloon is inflated. Pulmonary venous pressure is the best indicator of
left atrial pressure except when there is venoocclusive disease. AND ONLY
WHEN THE PA CATHETER IS IN ZONE 3 of the lung.
www.cardiozag.com
31. Pulmonary artery wedge 2-12
Pulmonary vein O2 content 20%
Pulmonary vein O2 sat 98%
PCWP tracing looks like RA tracing
except that the v wave is slightly higher
than the a wave (opposite of RA).
Also, b/c of the time required for LA
mechanical events, PAWP waveforms are
further delayed when recorded by EKG
Inflation of the Balloon for PCWP Tracing
www.cardiozag.com
34. •Don’t leave balloon inflated in wedge position for extended
period of time>can cause pulmonary infarction
• Thromboembolic events can occur with the catheter acting as
a nidus for thrombus formation. Less common with heparin
bonded catheters
•Misinterpretation of the data
•Mural thrombi can be induced by inflammation of infection of
a vessel wall, seen in 33% of patients at autopsy
•Sterile vegetations, seen in 90% of patients
•Endocarditis of the pulmonic valve
•Rupture of the catheter balloon and consequent air embolism
Not Without Risks???
www.cardiozag.com
36. IABP PURPOSE
Improves cardiac function during cardiogenic
shock.
26-28 cm balloon surrounds end of centrally
placed catheter (from groin)
Placed into descending thoracic aorta
Inflates in diastole - fills coronary arteries
retrograde
Deflates in systole - decreases LV afterload
www.cardiozag.com
37. What is an IABP?
The Intra-Aortic Balloon
Counterpulsation system is a
volume displacement device.
A device used to reduce left
ventricular systolic work, left
ventricular end-diastolic
pressure, and wall tension
Decreases oxygen
consumption
Increases cardiac output,
perfusion, pressure and
volume to Coronary Artries
47. ECG Trigger
Since triggering on the R wave of the ECG is
preferred, it is very important to give the IABP a
good quality ECG signal and lead
www.cardiozag.com
48. Triggering on the Arterial Pressure
Waveform
Arterial pressure provides another signal to the IABP to
determine where the cardiac cycle begins and ends
It is used when the ECG has too much interference from patient
movement or poor lead connection
There are limitations to triggering on the arterial pressure curve
• Therefore AP trigger should be considered a backup trigger
and not the one used as the primary trigger
www.cardiozag.com
49. The Guidelines
IABP in STEMI complicated by cardiogenic shock
Class 1B
ACC/AHA
ESC
Strongly recommended
Antman et al. Circulation 2004 / van de Werf et al. EHJ 2002 www.cardiozag.com
56. Indications for Temporary Pacing
Acute myocardial infarction with:
CHB, Mobitz type 2 AV block, medically
refractory symptomatic bradycardia, alternating
BBB, new bifascicular block, new BBB with
anterior MI
In absence of acute MI : SSS, CHB, Mobitz type 2
AV block
Treatment of tachyarrhythmias : VT
www.cardiozag.com
Thereby avoiding the discomfort of frequent punctures of the artery eg tests for blood gases, serial blood lactate levels, full blood count, u&e’s etc.
HYPOVOLAEMIA – ACCIDENTAL DISCONNECTION OF TUBING FROM THE CANNULA CAN RESULT IN SEVERE HAEMORRHAGE AND HYPOVOLAEMIA
NO DRUGS SHOULD BE ADMINISTERED THROUGH THE ARTERIAL LINE AS IT CAN CAUSE DISTAL ISCHAEMIA AND NECROSIS WITH SOMETIMES PERMANENT DAMAGE
LOCAL DAMAGE TO ARTERY – THIS IS THE MOST COMMON COMPLICATION. IT IS IMPORTANT TO KEEP AN EYE ON THE DISTAL END EG FINGERS WATCH FOR SIGNS OF CHANGE IN TEMPERATURE, MOTTLING OR BLANCHING PARTICULARLY WHEN THE LINE IS FLUSHED.
Why would the femoral vein be used as a last resort?
Several studies show that clinicians are poor at correlating clinic status with hemodynamic assessment. In a general ICU population, clinicians could correlate correlate PCWP and cardiac index only 30-70% of the time. And 60-85% of the time in CCUs.
People then argued that more frequent and accurate diagnosis of the conditions that can be treated would improve patient outcome. So in the 1970s, with Swan-Ganz, it became the standard of care in hemodynamically unstable patients.
Differentiation between causes of shock>cardiogenic, hypovolemic, septic
Differentiation between causes of pulmonary edema>cardiogenic versus noncardiogenic
Diagnosis of pericardial tamponade
Diagnosis of intracardiac shunt
Evaluation/Management of pulmonary hypertension
Diagnosis of lymphangitic spread of tumor and fat embolism
Management of complicated MI, HF
Determine need for vasopressor/inotropic therapy
Fluid Status>in GI bleed, renal failure, sepsis
Ventilator management>determining the best PEEP
Average time from decision to use PA catheter until onset of catheter based treatment is 120 minutes
Goal: get the catheter to the pulmonary artery
Cordis into right internal jugular vein or left subclavian allows easiest passage
Swan should be oriented ex-vivo to approximate the course in the body
Catheter goes through an introducer and into the vein. The balloon stays closed until we reach the right atrium.
When we reach the right atrium (20cm), balloon should be inflated to reduce possibility of injury to the myocardium.
Then the balloon should be moved quickly through the right ventricle (30cm)> and then pulmonary artery (40cm) and PCWP (50cm) FROM SUBCLAVIAN/IJ APPROACH
The balloon is inflated with air. But filtered CO2 should be used in any situation in which balloon rupture might cause air to get into arterial system>like if there is an intracardiac shunt or pulmary A-V fistula.
a=atrial contraction. A wave peak follows the electrical p wave by about 80msec
c=sudden motion of the AV ring toward the right atrium.
x descent=atrial relaxation
v=pressure generated by venous filling
of the right atrium. The peak of the v wave occurs at the end of ventricular systole when atrium is maximally filled. This occurs near the end of the t wave
y descent=rapid emptying of the RA into RV
Normal right atrial presssure is 0-6mmHg.
Normal oxygen content 15%
Normal O2 saturation 75%
Two pressures are measured in the RV. The peak of the RV systolic pressure and the RV end diastolic pressure, right after the a wave.
The ventricular diastole is made up of early rapid filling phase (60%) and a slow phase (25%) filling and an atrial systolic phase which produces an a wave in the RV tracing.
PA waveform is characterized by a systolic peak and diastolic trough with a dictrotic notch due to closure of the pulmonic valve. PA systolic pressure occurs within T wave of EKG similar to the systemic arterial pressures.
The measurement is obtained when the inflated balloon impacts into a slightly
smaller branch of the pulmonary artery. In this position, the balloon stop flows
and catheter tip senses pressure transmitted backward through the static column of
blood from the next pulmonary bed, the pulmonary veins. Pulmonary venous pressure is the
best indicator of left atrial pressure except when there is venoocclusive disease
The PCWP only indicates the LAP if the pressure in the surrounding capillaries exceeds the mean alveolar pressure. That is ZONE 3. This concept is based on the idea tha the lung can divided into 3 physiologic zones of blood flow which are based upon the relationship b/t alveolar pressure, PAP and pulm capillary pressure. In
ZONE 1, the alveolar pressure is greater than the capillary pressure. In Zone 3, the most dependent portion of the lung, vascular pressures are the highest d/t gravity. So again PCWP is only accurately a measure of LAP IF PCP exceeds mean alveolar pressure.
So how do you know you are in Zone 3? 60% of catheter insertion are only in the right place. You can look at the CXR and the catheter should be below the left atrium. If there is marked respiratory vairation in the PAWP tracing you are likely not in Zone 3 and if PAD> PCWP then you are likely not in zone 3.
Inflation of the balloon changes the tracing of the pulmonary artery. Goes from having a dicrotic notch to having more of a,c,v wave pattern like we saw in the right atrium. This is because we are measure left atrial pressure.
Pulmonary artery wedge 2-12
PCWP tracing looks like RA tracing
except that the v wave is slightly higher
than the a wave (opposite of RA)
B/c of the time required for LA mechanical
events, PAWP waveforms are further delayed when recorded by EKG. The peak of the A wave follows the the peak of the EKG p wave by 240 ms and the peak of the v wave occurs after the EKG t wave.
A wave=atrial systole
C wave=reflecting closure of the mitral valve
V wave=represents both ventricular systole and passive atrial filling in atrial diastole.
Pulmonary artery wedge 2-12
Pulmonary vein O2 content 20%
Pulmonary vein O2 sat 98%
Confirmation of the PCWP position is done be withdrawing blood from the distal lumen and measureing the O2 aturation. If >95% are considered satisfactory.
The PDP/DA influences the gradient for coronary artery perfusion
Irregular heart rates and irregular pulse pressures can cause the pump to not see a trigger where it expects to find one
If this happens, pumping will be temporarily interrupted as the computer relearns the parameters
Late deflation will also cause missed triggers and an interruption in pumping