Presentation on theme: "Hemodynamic Monitoring for the Respiratory Therapist"— Presentation transcript:
1Hemodynamic Monitoring for the Respiratory Therapist Jane Reynolds, MS, RN, RRT
2Definition of termsPreload – amount of blood in the ventricle before contraction – End diastolic volumeEDV determines the amount of ‘stretch’ that is placed on the myocardial muscleThat ‘stretch’ determines the strength of the next contractionThe strength of the contraction determines how much blood is pumped out of the ventricle during the next systole ‘stroke volume’The stroke volume determines the blood pressure and perfusing pressures
3Definition of termsAfterload - resistance to blood flow from the ventricle; work that must be done to pump blood from the ventricle to the circulationResistance determined by size of valve opening, blood viscosity and blood pressure in pulmonary or systemic circulationWork – is the oxygen consumed by the myocardium to overcome the resistance to flow
20Case Study 1An 18 year old white male was brought to the ED by CFD after being rescued from his car following a high speed collision with a parked truck. He is conscious, c/o of chest pain and is anxious. He was wearing his seat belt but still hit his chest on the steering wheel. His vital signs are: T 37, P 113, RR 23, B/P 100/ 70. CT scan of chest was unremarkable and he was brought to SICU for observation. He continued to have fluctuations in his blood pressure. A pulmonary artery catheter was placed.
21Case Study 1 Area Normal 8 am 10:30 11:00 CVP 10 4 8 PAP 28 6 22 PWP 0 to 81048PAP10 to 2228622PWP5 to 12157MAP70 to 105854070CO4 to 8 LPM188.8.131.52HR60 to 10011016095pH7.35 to 457.377.227.39PCO235 to 45455241PaO280 to 100655088PvO239 to 42392138
23Case Study 2A 72 year old white female was admitted to the MICU with an exacerbation of COPD. She has emphysema and chronic bronchitis and a 40 pack year history of cigarette smoking. Breath sounds are bilaterally diminished, crackles and rhonchi.She has JVD and pedal edema. A pulmonary artery catheter was placed as she had sustained hypotension and SOB. Her VS are: T 37, P118, RR 32, B/P 150/90, FiO2 .28, HB 22 Gm%.
24Case Study 2NormalNoon16001800CVP0 to 8252018PAP10 to 22503532PWP5 to 12151210MAP70 to 105607275CO4 to 8 LPM184.108.40.206HR60 to 1001109088pH7.35 to 457.357.397.38PCO235 to 45695551PaO280 to 100468578PvO239 to 423839
25Case Study 3A 25 year Hispanic male was admitted to the SICU after a thoracotomy for repair of his aorta following a gun shot wound to his chest. He has bilateral chest tubes. He is intubated and receiving full ventilatory support. His chest tube drainage for the last hour was 400 ml. He has bloody sputum and urine. His last CaO2 was10.4 volumes% with a PaO2 of 110 and saturation of 95%. VS T 36, P148, RR 14, B/P 65/44.
26Case Study 3Normal3 am5:3011:00CVP0 to 8248PAP10 to 221015PWP5 to 1265MAP70 to 105484060CO4 to 8 LPM2.943.55.7HR60 to 100150160140pH7.35 to 4220.127.116.11PCO235 to 455549PaO280 to 10011094PvO239 to 42292739
27Case Study 4A 52 year old white male with shortness of breath and chest pain was admitted to the ED. ECG showed ST elevation in 4 leads and his cardiac enzymes were markedly elevated. His vital signs were stable, SpO2 on NC at 2 LPM was 95%. He was taken to the cardiac cath lab and a diagnostic cardiac angiogram revealed 99% occlusion of his LAD. A coronary stent was placed and 15 minutes post intervention he began complaining again of severe SOB and chest pain. He was taken back to the cath lab. A pulmonary artery catheter was placed. A left heart catheterization revealed progression of the MI. His LVEDP is 32 and an intra aortic balloon was placed and counter pulsation started at 1:1.
28Case Study 4Normal9 am10:301600CVP0 to 8108PAP10 to 222820PWP5 to 123515MAP70 to 105724765CO4 to 8 LPM18.104.22.168HR60 to 10011080pH7.35 to 457.397.267.32PCO235 to 45405038PaO280 to 1004875PvO239 to 4236
30Case Study 5A 55 year old AA male was admitted to the MICU with acute SOB, cough, HTN and hypoxemia. He is oliguric and has required hemodialysis for the past 2 years. He is depressed and has not been following his dietary and fluid restrictions and has skipped his last 2 dialysis appointments. His VS are now T 37, P118, RR 35, B/P 200/135. He is receiving oxygen via venturi mask, FiO2 50%. He has a pulmonary artery catheter in place to monitor his cardiac status.
31Case Study 5Normal8 am10:3011:00CVP0 to 8251912PAP10 to 22403228PWP5 to 12221815MAP70 to 105150110100CO4 to 8 LPM22.214.171.124HR60 to 1009586pH7.35 to 457.327.39PCO235 to 454938PaO280 to 1006079PvO239 to 4234
32Case Study 6A 36 year old female was admitted to the ED with a CC of SOB and chest pain. She has no significant PMH, she does not smoke. She says that she hurt her ankle about two weeks ago and never went to the doctor about it. It is very painful and she has been almost immobilized for the past two weeks because it is just too painful to walk on. She has a cough and says her SOB came on rather suddenly after she went down to her basement to put some clothes in the laundry this morning. She is tachypneic, her MV is 12 LPM.
33Case Study 6Normal5 am24 hours laterCVP0 to 82512PAP10 to 224029PWP5 to 12109MAP70 to 1056575CO4 to 8 LPM6.45.1HR60 to 10011084pH7.35 to 457.367.39PCO235 to 454538PaO280 to 10085PvO239 to 4241
46CT Scan of ARDS35-year-old bone marrow transplant patient with respiratory failure from noncardiogenic pulmonary edema. The chest x-ray (left) shows a right sided pnbeumothorax, and bilateral ground glass density in the lungs. The HRCT scan (right) demonstrates relatively "airless" lungs despite high positive end expiratory pressure. The bronchovascular bundles are normal (A) suggesting that the hydrostatic pressure within the pulmonary capillaries is normal.