Hemodynamic Monitoring and Norms
Total volume pumped per minute- Cardiac Output
4-8L/min
Name 4 causes of shock.
Acute MI, severe hypoxemia, acidosis, hypoglycemia, cardiomyopathy, cardiac tamponade, dysrhythmias.
Name 4 causes of septic shock
Pneumonia, UTI, bacteria, abd infection, wound infection, invasive procedures, indwelling medical devices.
Neurogenic shock is due to a loss of balance between ____ and _____.
Sympathetic and parasympathetic nervous system.
Central venous pressure (CVP)
2-8mmHg
Cardiac output per body surface area-cardiac index
2.5-4L/min/m2
5 signs and symptoms of cardiogenic shock.
Weak peripheral pulses, decrease cardiac output, tachycardia, hypotension, cool/clammy skin, decreased capillary refill, increased CVP, Increased SVR, decreased O2 sat, JVD, chest pain, oliguria, confusion, agitated, dyspnea, pulmonary edema.
5 signs and symptoms of septic shock
Bounding pulses, mottled skin, increased CO, decreased CVP, tachycardia, decreased SVR from vasodilation, decreased BP, increased O2 sat, fever, increased resp rate, n/v/d, decreased gastric motility, increased inflammatory markers (CRP, WBC)
Name 4 Causes of neurogenic shock
Spinal cord injury (above T6, cervical), spinal anesthesia, nervous system damage, insulin reaction.
Pulmonary artery pressure (PAP)
Systolic ______
Diastolic ______
Systolic 15-28mmHg
Diastolic 5-16mmHg
Pressure in superior vena cava. Shows how much blood is returned to the right atrium from the superior vena cava (SVC)-Central venous pressure (CVP)
2-8mmHg
This medication increases heart rate, myocardial contractility, cardiac output, and rate of conduction through AV node with hemodynamic shock.
Dobutamine
4 treatments of septic shock
correct the underlying cause, fluid replacement, broad spectrum atb, vasopressors, neuromuscular blockades, sedation, and meds to prevent stress ulcers.
Signs and symptoms of neurogenic shock
Everything is decreased due to massive vasodilation (CO,HR,BP,CVP,SVR,O2 sat, skin warm and dry
Pulmonary artery wedge pressure (PAWP)
≤ 15mmHg
Average pressure in the systemic circulation through the cardiac cycle-mean arterial pressure (MAP)
60-100mmHg
4 causes of hypovolemic shock
Edema, ascites, vomiting, diarrhea, burns, trauma, bleeding, postpartum bleeding, multiple bone fractures.
Lab tests for septic shock
ABGs, lactic acid, glucose, electrolytes, blood cultures, coag tests.
Treatment for neurogenic shock.
Spinal precautions (SCI), assess and manage airway, inc HOB, IV fluids, inc risk for clots, vasopressors (epi, dobut, dopa).
Cardiac output (CO)
4-8L/min
The resistance it takes to push blood through the circulatory system to create blood flow- Systemic vascular resistance (SVR).
800-1200dynes/sec/cm
In hypovolemic shock, increased HCT means _____ and decreased HCT means _____.
Dehydration and Hemorrhage
1st line pressor for septic shock
Levophed (norepinephrine)
Neurogenic shock is an issue with this body system.
Nervous system
Type of line required to measure the CVP, PAP, PAWP, and CO
Swanganz catheter