HESI Critical Care Cardiac Hemodynamics.pdf

Blood vessels in body are dilated but pulmonary

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Blood vessels in body are dilated but pulmonary vessels are constricted. Low SVR, High PVR. CM : hives. Swelling. Angioedema (swelling around face). SOB. Wheezing. Treatment : -epinephrine (short acting; need to go to hospital). -Bronchodilators. -Oxygen. -Steroids. -Antihistamines. -Fluids (because all fluids are in tissues). 3. Septic : caused by infection. SIRS (systemic inflammatory response syndrome). Get inflammatory response in whole body, not just one place. Causes vasodilation decrease afterload (resistance/SVR/PVR). Increased capillary permeability fluid goes from blood vessels to tissues decreases preload (volume/CVP/PAWP). CM: tachycardia, tachypnea, fever, increased WBCs. Initially skin is warm & flushed progresses to cold & weak pulses. Decreased cardiac output. Risk for ARDS because inflammatory cells go to other places. Risk for DIC. Treatment: -blood culture for everything (PAN culture; blood, urine, sputum) Antibio tics (don’t have to wait for culture to come back before starting meds. Want first antibiotic done before 1 st hour of pt being in hospital). -Vasoconstrictors ( levophed ; not dopamine because HR is increased already). -Fluids ( give fluids first before vasoconstrictors ; fill the tank before you squeeze. Give bolus first). -Steroids (treat inflammation). Multiple Organ Dysfunction Syndrome (MODS) Progressive dysfunction of two or more organ systems Can occur after any severe injury or illness Results in maldistribution of blood flow to organs Organs severely affected -Lungs, Splanchnic bed (vascular bed innervating the abd organs like spleen, liver, and part of intestines), Liver, Kidneys Clinical Manifestations : as your systems fail, what are you going to see? Collaborative Management : treating organ systems that have failed. Treat underlying shock. -Ex. If kidneys failed, put them on dialysis. If lungs failed, put them on ventilator. High mortality rate. Seen in shock. Pts with 2 organ failure have 50% mortality rate. Pts with 3 or more organ failure have 80- 100% mortality rate. Shock, Sepsis, MODS Patient outcomes/Goal: Improved tissue perfusion 1. Alert, oriented 2. Normotensive 3. Warm, dry skin 4. Adequate urine output 5. Normal hemodynamics 6. Lab values within normal limits 7. Absence of infection 8. Intact skin
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