The Ups & Downs
(Vasoactive Medications)
(Vasoactive Medications)
These two inotropic medications will increase CI, SVR and HR.
What are epinephrine and dopamine?
This could be a cause for diminished or absent breath sounds on the left side of the chest post ET tube insertion.
What is right mainstem intubation?
These receptor sites are located primarily in the periphery of the body.
What are Alpha Receptor Sites?
This is a device that is commonly needed more frequently in patients who have had valve surgery.
What is a temporary pacemaker?
Discuss: What rate would you set it at?
This lab value requires close monitoring, and aggressive treatment, in post cardiac surgery patients, particularly when the patient is on an epinephrine drip (which will cause elevated levels).
Controlling this will reduce risk for infection post operatively.
What is blood glucose?
This is a medication I would use to lower BP if it exceeds the ordered limits (e.g. 140/70 with orders to maintain SBP between 100-120)
What is nicardipine (Cardene)?
(nipride, tridil)
True/False
A patient has a BP of 88/45, CI 1.9, CT output of 160 over the last hour, and an FiO2 of 60 on their last ABG. They are awake and alert, following commands. They are ready to wean from the ventilator.
What is false?
What parameters would stop you from weaning a patient from the ventilator?
The amount of blood ejected from the ventricles each minute. Calculated as HR X SV.
What is Cardiac Output?
This complication can cause low BP and CO as the patient reaches normothermia.
BONUS: How would you treat these hemodynamic changes?
What is hypothermia?
OR
What is vasodilation?
BONUS: Fluids. (Remember, vasodilation means you have a bigger "tank" and therefore lower pre-load, requiring additional fluids to "fill the tank")
This electrolyte should be monitored closely and treated aggressively, particularly if the patient is bleeding and receiving blood products.
What is ionized calcium?
(Remember! PRBCs contain citrate to prevent clotting. Citrate binds to calcium, lowering ionized calcium levels.)
(what else might you monitor? K+, ptt...)
This medication is a vasodilator and will reduce BP, primarily by vasodilation of the venous system and reducing preload.
What is nitroglycerine (Tridil)?
This value on an ABG would not affect a patients readiness to wean from the ventilator.
What is HCO3?
ABG Guidelines:
pH: 7.35-7.52
PaCO2: 35-45
PaO2: >=65
SaO2: >=92%
When the CI is low, hemodynamic evaluation should start with this assessment.
What is preload?
In general, assess hemodynamics in this order:
Preload - afterload - contractility
In this situation, fluids would continue to be given, despite an elevated CVP.
What is cardiac tamponade?
Discussion: What are you going to do about it, and why?
My proctored exam will be given extra credit if this criteria is met.
What is bringing coffee for my instructor?
(Just kidding!)
This inotropic medication will increase CI, and decrease SVR. It has a half-life of about 3 hours.
What is milrinone (Primacor)?
Increased PEEP has this effect on hemodynamics.
What is reduced cardiac output due to increased pressure in the closed compartment of the thoracic cavity (chest).
These values reflect right and left sided afterload.
What are PVR (right) and SVR (left)?
This is the first line of treatment for bleeding, and is assumed to be the problem until proven otherwise.
What is coagulopathy?
Discussion: How will we treat this?
This is a lab I would want to check after giving large amounts of fluid, or if my patient is hypoxic.
What is H&H?
These two inotropic medications will increase CI, but may also result in lowered BP because of vasodilation (lower SVR).
What are milrinone and dobutamine?
There are the actions I would take if a patient were to self extubate.
What is turn off sedation, administer oxygen and assess respiratory status?
Discussion: Would you need to reintubate?
What additional tasks would you need to complete?
These values reflect left sided preload.
What are PAD and PAWP?
CPR will NOT be my first action in a patient who is in VF only in this situation.
What is when I can defibrillate within 60 seconds?
Discussion: What is Banner Policy?
This may cause my patient to become intravascularly dry (reduced preload) in the immediate post operative period.
What is excessive diuresis?
OR
What is capillary leak?