Most common arrhythmia with Swan placement
PVC
Name the method by which Cardiac Output is determined
Thermodilution
Chemical secreted by posterior pituitary that aids in water retention and smooth muscle constriction
Vasopressin
4 Factors that affect Cardiac Output
1. HR
2. Contractility
3. Preload
4. Afterload
62yoM s/p CABG having difficulty weaning from cardiopulmonary bypass. HR 102, BP 86/40, CI 1.7, CVP 16, PAP 30/18, SVR 1900. What non-pharmacologic adjunct could be used to get this patient off the table so the surgeon can make his tee-time?
IABP
Most common cardiac arrhythmia that typically arises on POD2/3
Atrial fibrillation
Name at least 3 Complications in placing a Swan
Arrhythmia
PTX
PA rupture/Hemothorax
Infection
T
Bedside RN calls you at 2am. What numbers on the monitor should you ask for?
HR, BP, CVP, CI, SVR, SvO2
(UOP, CT output)
62yoM s/p CABG 5 hours ago with HR 102, BP 86/40, CI 1.7, CVP 20, PAP 50/30, SVR 1900. RN increased Pressor doses without improvement.
Tamponade
Lidocaine suppresses this dangerous arrhythmia
Ventricular Tachycardia
Depth at which most Swans are placed
~50cm
Primary action of Dopamine based on dosage...
1. low dose (<5mcg/kg/min)- D1/2 receptors
3. medium dose (5-15mcg/kg/min) - Beta
3. high dose (>15mcg/kg/min) - Alpha
What 2 factors cause Pulmonary Vasoconstriction
Hypoxemia
Hypercapnia
62yoM s/p CABG 5 hours ago with HR 90, BP 92/50, CI 1.7, CVP 5, PAP 22/10, SVR 1900. RN asking for your help. Next step in management...
Fluid bolus
Electrical concern following valvular surgeries
Complete Heart Block
1o - Prolonged PR
2o - Mobitz 1/2
3o - CHB
Normal Cardiac Index
>2.2 LPM/m2
Electrolyte mainly responsible for increasing contractility
Calcium
(treat when <1mmol/L)
The change in the amount of blood ejected from the left ventricle into the aorta with each heartbeat
SVV
(treat typically when >10-15%)
62yoM s/p CABG 5 hours ago with HR 102, BP 86/40, CI 2.5, CVP 14, PAP 24/12, SVR 400. RN gave fluid bolus. She calls exasperated...
Alpha agent, such as norepinephrine
If persists... Methylene Blue (antagonizes NO and blocks cGMP, scavenger of free radicals)
Causes of Tachycardia in the Postop CT patient
Pain, Bleeding, Hypovolemia, Atrial Fibrillation, BetaBlocker withdrawal, Pulmonary embolism, ETOH withdrawal, others...
What pressure finding confirms catheter successfully floated inside pulmonary artery?
Elevation of diastolic pressure
Phosphodiesterase Inhibitor that acts as an Inotrope and vasodilator?
Milrinone
blocks one of the five subtypes of PDE which prevents the inactivation of cAMP and cGMP
Most common EKG finding of Blunt Cardiac Injury
Tachycardia
62yoM with DM/HTN presented to the ER with acute onset of chest pain. He became "hypotense" and required intubation. MICU admitted him and floated a swan. VS: HR 102, BP 86/40, CI 1.5, CVP 16, PAP 35/20, SVR 1900. RN just called and wanted to know all about cardiogenic shock.
In 10 seconds, name as many causes of cardiogenic shock as you can... GO!
acute myocardial infarction
pulmonary embolism
myocarditis
valvular heart disease
endocarditis / sepsis
drug overdose
tamponade
blunt cardiac injury