Upon entering the room you notice a "wedge" waveform on the monitor. The balloon is not inflated. What should you recommend?
What is withdraw the catheter.
100
Which hemodynamic measure is increased in cor pulmonale and tricuspid valve stenosis?
What is CVP.
100
1. You’re evaluating your ICU patient that was admitted with syncope and shock. The patient has a pulmonary artery catheter inserted. The patient data is as follows:
MAP 45 mmHg
CVP 11 mmHg
PAP 46/16 mmHg (26 mmHg)
PCWP 6 mmHg
Based on these results, the patient should be treated for:
a. ARDS
b. Left heart failure
c. Right heart failure
d. Hypervolemia
What is A: ARDS
100
A pulmonary artery catheter shows the following measurements.
CVP 6 mmHg
PAP 40/20 mmHg (27)
MAP 90 mmHg
The intensivist asks you for the source of the patient’s problem. The correct response is that the patient has a problem with his:
a. Pre-load
b. After-load
c. Contractility
d. Chronotropic control
What is B: Afterload (right ventricular)
100
What effect does high intrathoracic pressures have on left ventricular afterload?
What is it decreases afterload.
200
The transducer is sitting on the patients stomach. How will this effect the patients blood pressure reading?
What is it will cause the values to read higher than they actually are.
200
Which hemodynamic measurement is increased with pulmonary hypertension, ARDS, or a PE?
What is PAP.
200
PAP 45/18 mmHg
PCWP 5 mmHg
Based on these findings, it appears the patient has
a. Pulmonary hypertension
b. Mitral valve stenosis
c. Septic shock
d. Hypervolemia
What is A: Pulmonary hypertension
200
Your ARDS patients is requiring large amount of pressure to maintain adequate ventilation. The patients CVP is low. What do you recommend?
What is administer fluids.
200
What does pulmonary hypertension do to pulmonary vascular resistance?
What is it increases PVR.
300
The pulmonary artery catheter has a blood clot. What are the steps that must be taken to fix this problem?
What is
1. aspirate
2. flush the catheter
3. rotate catheter
300
Which hemodynamic measure is increased with CHF or mitral valve stenosis?
What is PCWP.
300
CVP 10 mmHg
PAP 25/5 mmHg
PCWP 8 mmHg
Based on these results you should recommend that the patient be treated for:
a. Hypovolemic shock
b. Tricuspid valve stenosis
c. Right heart failure
d. Congestive heart failure
What is C: Right heart failure
300
What is the patients optimal PEEP?
Time PEEP SaO2 SvO2
a. 7:00 7 85% 45%
b. 8:00 12 87% 55%
c. 9:00 15 93% 65%
d. 10:00 17 96% 59%
What is C: 15 cm H2O
300
What is the name for the amount of blood pumped out of the heart with each beat?
What is stroke volume.
400
When monitoring a patients waveform on a pulmonary artery catheter, you notice that the normal dicrotic notch is not seen. What is this called?
What is pressure dampening.
400
Which hemodynamic measurement gives you information about the lungs?
What is PAP.
400
CVP 5mmHg
PAP 35/18 mmHg (24 mmHg)
PCWP 12 mmHg
Based on the provided information, you should contact the attending physician and report that the patient has developed:
a. Hypervolemia
b. Congestive heart failure
c. Cor pulomonale
d. ARDS
What is D: ARDS
400
What is the patients optimal PEEP?
Time PEEP SaO2 SvO2
a. 7:00 5 75% 60%
b. 8:00 7 80% 65%
c. 9:00 10 85% 70%
d. 10:00 15 85% 70%
What is C: 10 cm H2O
400
High levels of peep can cause a __________ shift of the interventricular septum.
What is a leftward shift.
500
What can cause pressure dampening?
What is an obstruction (blood clot, bubble, kinking, etc.)
500
Which hemodynamic measurement gives you information about the left heart?
What is PCWP.
500
CVP 1 mmHg
PAP (9 mm Hg)
PCWP 3 mmHg
Which of the following is the patients most likely diagnosis?
a. Congestive heart failure
b. Hypovolemia
c. Cor pulmonale
d. Pulmonary hypertension
What is B: Hypovolemia
500
Time PEEP SaO2 SvO2
7:00 10 70% 40%
8:00 12 80% 55%
9:00 20 80% 50%
10:00 25 75% 45%
What happened at 9:00 (when compared to previous times)?
a. Cardiac output increased
b. The patient developed a respiratory acidosis
c. Compliance increased
d. Oxygenation decreased
What is D: Oxygenation decreased
500
Approximately what % of PEEP gets transferred to the central veins?