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diagnosis management differential cardiology pharmacology criticalcare algorithm table comparison causes pathophysiology shock treatment pulmonary inotropes toxicology vasopressors clinical pocus chronic
Mean Arterial Pressure (MAP) Average arterial pressure throughout one cardiac cycle, systole, and diastole. Surrogate indicator of
Cardiac Output (CO ... Stroke Volume (SV ... affected by the chronotropy ... afterload #Heartrate #chronotropy ... #SV #lvdv
POCUS - Measuring Cardiac Output 1) Calculate LVOT Area 2) Calculate LVOT VTI 3) Calculate Cardiac Output SV = (LVOT
Cardiac Output SV ... ) x (LVOT VTI) CO ... LVOT VTI) X HR CO ... (mL/min) = SV ( ... Cardiac #Output #CO
Vasopressors and Inotropes - Pharmacology Summary Vasopressors Phenylephrine (alpha-1) • Increases BP, SVR • Risk of reflex bradycardia
Increases BP, SVR, CO ... Increases HR, SVR, CO ... not inotropic/chronotropic ... contractility, CO ... • Increases CO
Stroke Volume & Cardiac Output Measurement on POCUS Accurately measure LVOT diameter: 1. Obtain PLAX 2. Zoom to
around PWD trace CO ... LVOT Diam/2) 2 SV
Calcium Channel Blockers - Dihydropyridines vs Non-Dihydropyridines Dihydropyridines (amlodipine, felodipine, nifedipine, nicardipine) • SVR: Decrease • Inotropy:
: No effect • Chronotropy ... Inotropy: Decrease • Chronotropy
Perform computations online at: ScyMed.com 6th ED ICU-card «ICU, Formulas & Drugs» HEMODYNAMIC PATTERNS Condition SAP CVP PAP PCWP CO C(a-v)02 PVR SVR Hypovolemic shock ↓ ↓ ↓ ↓ ↓ ↑ ↑ ↑ Cardiogenic shock ↓ 1 ↑ 1 1 ↑ Septic shock ↓ ↓ ↓ ↓ ↑ ↓ ↓ ↓ Cardiac Tamponade . ↑ ↑ 1 ↓ → ↑ RV
PAP PCWP CO ... L/min/m2 HR*SV ... /SV Heart Rate ... SV 69-87 mL/beat ... CO/HR Stroke
Shock Classification and Differential Diagnosis SHOCK • MAP <65, SBP <90, drop in SBP > 40 •
Distributive: • High CO ... Cardiogenic: • Low CO ... Obstructive: • Low CO ... Hypovolemic: • Low CO
Shock - Differential Diagnosis Framework MAP = CO x SVR Hypovolemic (↓ Intravascular volume): • Hemorrhage, dehydration due
Framework MAP = CO ... third-spacing • ↓ CO ... arrhythmia • ↓ CO ... PE, PAH • ↓ CO ... drugs/toxins • ↑ CO
Clinician's Pocket Guide to Vasopressors - Receptor Profiles and Hemodynamic Parameters • Systemic Vascular Resistance -
contractions • Chornotropy
Carbon Monoxide Poisoning Symptoms are non-specific: - Headache 90% - Nausea/vomiting 50% - Vertigo 50% - Altered
questions: - Co-ocupants ... - Alarm (for CO
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