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diagnosis management differential criticalcare cardiology pharmacology algorithm causes shock treatment pathophysiology pulmonary table comparison toxicology clinical inotropes pocus vasopressors chronic
Mean Arterial Pressure (MAP) Average arterial pressure throughout one cardiac cycle, systole, and diastole. Surrogate indicator of
Cardiac Output (CO ... Stroke Volume (SV ... dromotropy, and lusitropy ... chronotropy #dromotropy #lusitropy ... #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
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
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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