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Hemodynamic Monitoring for the Respiratory Therapist Jane Reynolds, MS, RN, RRT.

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Presentation on theme: "Hemodynamic Monitoring for the Respiratory Therapist Jane Reynolds, MS, RN, RRT."— Presentation transcript:

1 Hemodynamic Monitoring for the Respiratory Therapist Jane Reynolds, MS, RN, RRT

2 Definition of terms Preload – amount of blood in the ventricle before contraction – End diastolic volume –EDV determines the amount of ‘stretch’ that is placed on the myocardial muscle –That ‘stretch’ determines the strength of the next contraction –The 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

3 Definition of terms Afterload - resistance to blood flow from the ventricle; work that must be done to pump blood from the ventricle to the circulation Resistance determined by size of valve opening, blood viscosity and blood pressure in pulmonary or systemic circulation Work – is the oxygen consumed by the myocardium to overcome the resistance to flow

4 CirculatIonCirculatIonCirculatIonCirculatIon

5 Normal Circulatory Pressures 1. Preload to RV 2. Afterload to RV 3. Preload to LV 4. Preload to LV 5. Afterload to LV 1 2 3 3 5

6 Circulation

7 Alveolar Capillary Membrane

8

9 Normal Alveolar Capillary Membrane

10 Begin Pulmonary Edema

11 Interstitial Edema

12 Pulmonary Edema - Late

13 Pulmonary Artery Catheter

14

15

16 Arterial Blood Gas Interpretation

17 Oxygenation Saturation PO 2 27 mmHg 50% 40 mmHg 75% 60 mmHg 90% 95 mmHg 97% 150 mmHg 100%

18 Oxyhemoglobin Dissociation Curve

19 Pulmonary Artery Catheter in Wedge Position

20 Case Study 1 An 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.

21 Case Study 1 Area AreaNormal 8 am 10:3011:00 CVP 0 to 8 0 to 81048 PAP 10 to 22 28622 PWP 5 to 12 5 to 1215710 MAP 70 to 105 854070 CO 4 to 8 LPM 5.92.55.7 HR 60 to 100 11016095 pH 7.35 to 45 7.377.227.39 PCO 2 35 to 45 455241 PaO 2 80 to 100 655088 PvO 2 39 to 42 392138

22 Cardiac Tamponade

23 Case Study 2 A 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. A 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, FiO 2.28, HB 22 Gm%. 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, FiO 2.28, HB 22 Gm%.

24 Case Study 2 NormalNoon16001800 CVP 0 to 8 0 to 8252018 PAP 10 to 22 503532 PWP 5 to 12 5 to 12151210 MAP 70 to 105 607275 CO 4 to 8 LPM 3.94.54.7 HR 60 to 100 1109088 pH 7.35 to 45 7.357.397.38 PCO2 35 to 45 695551 PaO2 80 to 100 468578 PvO2 39 to 42 353839

25 Case Study 3 A 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 CaO 2 was A 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 CaO 2 was 10.4 volumes% with a PaO 2 of 110 and saturation of 95%. VS T 36, P148, RR 14, B/P 65/44. 10.4 volumes% with a PaO 2 of 110 and saturation of 95%. VS T 36, P148, RR 14, B/P 65/44.

26 Case Study 3 Normal 3 am 5:3011:00 CVP 0 to 8 0 to 8248 PAP 10 to 22 10815 PWP 5 to 12 5 to 126510 MAP 70 to 105 484060 CO 4 to 8 LPM 2.943.55.7 HR 60 to 100 150160140 pH 7.35 to 45 7.227.207.32 PCO2 35 to 45 555549 PaO2 80 to 100 11094110 PvO2 39 to 42 292739

27 Case Study 4 A 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. A 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.

28 Case Study 4 Normal 9 am 10:301600 CVP 0 to 8 0 to 8108 PAP 10 to 22 2820 PWP 5 to 12 5 to 123515 MAP 70 to 105 724765 CO 4 to 8 LPM 4.92.54.4 HR 60 to 100 1108065 pH 7.35 to 45 7.397.267.32 PCO2 35 to 45 405038 PaO2 80 to 100 654875 PvO2 39 to 42 2836

29 Intra Aortic Balloon Counter Pulsation

30 Case Study 5 A 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, FiO 2 50%. He has a pulmonary artery catheter in place to monitor his cardiac status. A 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, FiO 2 50%. He has a pulmonary artery catheter in place to monitor his cardiac status.

31 Case Study 5 Normal 8 am 10:3011:00 CVP 0 to 8 0 to 8251912 PAP 10 to 22 403228 PWP 5 to 12 5 to 12221815 MAP 70 to 105 150110100 CO 4 to 8 LPM 3.44.15.7 HR 60 to 100 1109586 pH 7.35 to 45 7.327.39 PCO2 35 to 45 4938 PaO2 80 to 100 6079 PvO2 39 to 42 3438

32 Case Study 6 A 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.

33 Case Study 6 Normal 5 am 24 hours later CVP 0 to 8 0 to 82512 PAP 10 to 22 4029 PWP 5 to 12 5 to 12109 MAP 70 to 105 6575 CO 4 to 8 LPM 6.45.1 HR 60 to 100 11084 pH 7.35 to 45 7.367.39 PCO2 35 to 45 4538 PaO2 80 to 100 6585 PvO2 39 to 42 3841

34 Saddle Pulmonary Embolism

35

36 Questions?? Thank you! You were great!!

37

38 Thoraco-abdominal Pump Mechanism

39 Small Vessels

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41 Venous return

42 Oxygen carried in the blood

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44 Chest x-ray of ARDS

45 Normal Chest x-ray

46 CT Scan of ARDS

47

48 Left-Sided Heart Failure Pulmonary congestion occurs when left ventricle cannot pump well Dyspnea upon exertion, orthopnea, and paroxysmal nocturnal dyspnea Oliguria

49 Right-Sided Heart Failure Congestion of viscera and peripheral tissues when right ventricle fails Jugular vein distention Dependent edema HepatomegalyAscites Weakness, anorexia, and nausea Weight gain

50

51 Sphincters Open

52 Sphincters Closed

53 Path of Blood

54 Major Blood Vessels


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