Fiser Chapter 16 CRITICAL CARE Flashcards Preview

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Flashcards in Fiser Chapter 16 CRITICAL CARE Deck (109)
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1

Normal CO

4-8 L/min

2

Normal CI

2.5-4 L/min/m^2

3

Normal SVR

800-1400

4

Normal PCWP

11 +/- 4 (7-15)

5

Normal CVP

7 +/- 2

6

Normal PAP

25/10

7

Normal SvO2 (mixed venous O2 sat)

75

8

MAP equation

MAP = CO x SVR

9

CI equation

CI = CO/BSA

10

Blood flow to organs

25% kidney
15% brain
5% heart

11

EF equation

SV/LVEDV

(LVEDV-LVESV)/LVEDV

12

Anrep effect

automatic increase in contractility 2/2 increased afterload

13

Bowditch effect

automatic increase in contractility 2/2 increased HR

14

CaO2 (arterial O2 content) equation

CaO2 = Hgb x 1.34 x O2 sat + (pO2 x 0.003)

15

O2 delivery equation

CO x CaO2 x 10

16

VO2 (O2 consumption) equation

VO2 = CO x (CaO2 - CvO2)

Normal O2 delivery-to-consumption ration 5:1
CO increases to keep this constant

O2 consumption is usually supply independent

17

Right shift O2-Hgb dissociation curve causes (increased O2 unloading)

CADET

Increased CO2, ATP production, acidosis, 2,3-DPG production, elevation, temperature

Normal p50 (O2 at which 50% of O2 receptors saturated) = 27 mm Hg

18

Causes of increased SvO2 (saturation of venous blood)

Normally 75%
Increased in shunt or decreased O2 extraction (sepsis, cirrhosis, CN tox, hyperbaric O2, hypothermia, paralysis, coma, sedation)

19

Causes of decreased SvO2 (saturation of venous blood)

Normally 75%
Decreased in increased O2 extraction or decreased O2 delivery (decreased O2 sat, decreasedCO, malignant hyperthermia)

20

Wedge may be thrown off by

Pulm HTN
Aortic regurgitation
Mitral stenosis
Mitral regurgitation
High PEEP
Poor LV compliance

21

Swan-Ganz cath placement

Zone III (lower lung)
R SCV 45 cm L SCV 55 cm
R IJ 50 cm L IJ 60 cm

PVR can be measured only with Swan-Ganz (not Echo)

Wedge pressure should be measured at end-expiration

22

What do you do if there is hemoptysis after flushing Swan-Ganz cath?

Increase PEEP to tamponade pulmonary artery bleed
Mainstem intubate non-affected side
Fogarty balloon down mainstem on affected side
May need thoracotomy and lobectomy

23

What are the relative contraindications to Swan-Ganz cath?

Previous pneumonectomy
Left bundle branch block

24

Primary determinants of myocardial O2 consumption

Ventricular wall tension and HR
Increase can lead to MI

25

Normal alveolar-arterial gradient

10-15 mm Hg in normal nonventilated patient

26

What blood has the lowest venous saturation?

Coronary sinus blood (30%)

27

Shock definition

Inadequate tissue oxygenation

28

Adrenal insufficiency MCC

Withdrawal of exogenous steroids

29

Adrenal insufficiency manifestations

CV collapse, unresponsive to fluids and pressors
nausea, emesis, abdominal pain, fever, lethargy, decreased glucose, hyperkalemia

Tx: dexamethasone

30

Steroid potency

1x cortisone, hydrocortisone
5x prednisone, prednisolone, methylprednisolone
30x dexamethasone