Complex Care Session 10: hemodynamic monitoring in shock

Session 10: hemodynamic monitoring in shock

 

MAP: mean arterial pressure (average of systolic and diastolic BP)

  • We want it above 65 mmHg 

Systolic BP: want this to be above 90 mmHg in most cases for adequate perfusion

 

Pulse pressure

  • SBP -DBP: greater than 40 is vasodilation. Less than 40 is vasoconstriction.
    • In septic shock there is vasodilation
    • In cardiogenic shock there will be vasoconstriction.

 

CVP – central venous pressure. Venous central line that measures end vena cava pressure.

ABP – Arterial blood pressure. Catheter inserted into the radial or femoral arteries usually. The tubing is pressurized to overcome the arterial blood pressure. To get an accurate reading the fixture that measures the pressure must be level with the patient.

 

Changes in venous O2 or Arterial O2 (SvO2 vs ScvO2)

  • Increased O2 delivery from: increased SaO2, Increased HGB, Increased cardiac output
  • Decreased O2 consumption: decreased need(hypothermia), access(vasoconstriction), and capability(tissue death)
  • Decreased O2 delivery: decreased O2 sat, decreased HGB, decreased CO
  • Increased

 

Shock:

Shock HR BP RR UO SVO2
Cardiogenic up down (Low PP)  Up w/ crackles down down
Hypovolemic up down (Low PP)  Up then D down down
Neurogenic down down (high PP) dysfunction dysfunction Normal to high
Anaphylactic up down (high PP) up incontinence Normal to high
Septic up down (high PP) up Down (none) Down, increased late
obstructive up down (Low PP) up down Normal to down

 

Cardiogenic shock: pump issue

  • Decreased stroke volume, decreased stroke volume
  • Causes MI, arrhythmias,
  • s/s: tachypnea, crackles, anxiety,

Hypovolemia: decreased fluid volume

  • absolute hypovolemia: hemorrhage, DI, Diuretics
  • Relative hypovolemia: fluid moving out of the vasculature into extra vasculature. Burns and liver failure.
  • Increased HR, CO, RR
  • Decreased: SV, CVP, PAP (pulmonary arterial pressure)
  • The body can compensate for about a 15% volume deficit

 

Distributive: poor distribution of circulating blood.

  • Neurogenic shock:
    • T6 or above trauma
    • Hypotension, bradycardia, vasodilation relative hypovolemia,
  • Anaphylactic reaction
    • Profound vasodilation, capillary permeability, edema, leading to bronchospasm
    • Angioedema(facial swelling), hives

obstructive:  physical blockage to flow.

  • Cardiac tamponade
  • Pulmonary embolism

 

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