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Preload
R - CVP
L - PAWP
Afterload
SVR
PVR
Normal CVP
2-8 mmHg
Normal PAWP
6-12 mmHG
Normal SVR
900-1400
Normal PVR
50-250
Fluid per hour from flush device
3cc/hr
Invasive line parameters
HoB Flat - 60
Re zero Q8 or on patient change
Trouble shooting
Check all connections
Check tubing
Check Patency
Check flush bags
re-zero
re-level
check patient position
Port Usage
TPN - M
High volume fluids - D
Blood - D
CVP - D
Removing Cath.
Hold until bleeding stops
MAP Calculation
2(DBP) + SBP / 3
Pre-Procedure
Allen test
Dicrotic notch
Aortic valve closure
Pulsus paradoxus
Decrease in systolic pressure > 10 mmHg during inspiration

Severe dehydration
Art Line Comp.
Infection
Air embolus
hemorrhage
PAC Insertion

Anatomy
Yellow = PA Distal
Blue = CVP
Balloon port (3cc syringe)
Thermister port
Introducer
VIP
RV
Oximetric
Pacing
PA Cath insert
emergency drugs
Lidocaine
PA Cath insertion
Monitor EKG
Look for wedged wave form
can use immediately
PA Cath post insertion
CXR
Heart/Lung sounds
PA Cath Documentation
time
p&f education
type and size
graphic
site
difficulties
confirmation
initial values
PA Cath readings
Only inflate with the minimmum air required to get a wave form
PA Cath comp
Pulmonary art rupture
Pulmonary infarction
heart valve damage
Dysrhythmias
Infection
PA Wave troubleshooting
Connections
air or blood in tubing
line patency
solution bags
rezero
patient position
Obtaining CO
Injection of fluid < 4 sec
At end expiration
Normal CO
4-8L min
Cardiac output Waves
Inverse relation, longer/lower the wave, the less CO
Treatment of elevated HR
Beta blockers (Lopressor)
CCB (Cardiazem)
Tx of dec. HR
Atropine if symptomatic, epi,
TX of elevated preload
venodilators (NTG, MSO4 diuretics)
TX of low preload
Volume or vasopressors
tx of high contractility
Beta blockers, CCB
tx of low contractility
Inotropic drugs (digitalis, dopamine, milrinone, dobutamine)
Drugs to give in a code
  1. Epi
  2. Vasopressin
  3. amiodarone
  4. atropine
Primary ABCD Survey
A-irway
B-reathing
C-irculation
D-efibrilation
Secondary ABCD survey
A-irway
B-reathing
C-irculation
D-isability
E-xpose extremities
F-ingers, foley flip
G-astric tube
H-istory
Quardrad 3
Oxygen
Monitor
IV Fluids
Quadrad 4
Temperature
Heart Rate
Blood Pressure
Respirations
Quadrad 5
Tank (vol)
Tank (resistance)
Pump
Rate
Types of shock
Hypovolemic
Cardiogenic
Distributive
Hypovolemic shock
Anxiousness, pale clamy skin, flattened neck veins
tachy, confusion
Hypovolemic shock hemo changes
Decreased CVP, decreased PAP, decreased CO, increased SVR
Cardiogenic shock causes
Card. Shock Symp
Pain in chest, n/v, diaphoresis
Card Hemo Changes
increased cvp, increased PA, increased SVR, CO decreases
Cardio shock int.
High flow O2, inotropics (dobutamine, dopamine)
Septic Shock causes
endotoxins, immune system caused vasodilation
Severe sepsis
Inflammation, Coagulation and activated protein, impaired fibrinolysis, endothelium encourages coagulation
Septic shock stages
Sepsis, severe sepsis, septic shock
Septic Shock presentation
2 or more changes in body temp, heart rate, resp. funtion, and leukocyte count
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