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diagnosis management differential criticalcare cardiology pharmacology algorithm causes shock treatment pathophysiology pulmonary table comparison toxicology clinical inotropes pocus vasopressors chronic
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
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
Mean Arterial Pressure (MAP) Average arterial pressure throughout one cardiac cycle, systole, and diastole. Surrogate indicator of
Cardiac Output (CO ... (CVP) MAP = (CO ... Cardiac output (CO ... Stroke Volume (SV ... #SV #lvdv
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
Vasopressors and Inotropes - Pharmacology Summary Vasopressors Phenylephrine (alpha-1) • Increases BP, SVR • Risk of reflex bradycardia
Increases BP, SVR, CO ... Increases HR, SVR, CO ... contractility, CO ... • Increases CO
Carbon Monoxide Poisoning Symptoms are non-specific: - Headache 90% - Nausea/vomiting 50% - Vertigo 50% - Altered
questions: - Co-ocupants ... - Alarm (for CO
Right Heart Catheterization Cheat Sheet: Interpretation of Pressures and Waveforms Direct measurements ● Central venous pressure
Cardiac output (CO ... pressure – CVP]/CO ... mean PAp – PCWP]/CO ... /min/m2) (CI = CO
Simplified Vasopressors and Inotropes Comparison Chart MAP = CO x SVR Dobutamine - Norepinephrine - Epinephrine - Phenylephrine
Comparison Chart MAP = CO
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