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Critical Care

Dale A. Dangleben; Firas Madbak; Jayme Lieberman

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    AMA Citation
    Dangleben DA, Madbak F, Lieberman J. Dangleben D.A., Madbak F, Lieberman J Dangleben, Dale A., et al.Critical Care. In: Dangleben DA, Lee J, Madbak F. Dangleben D.A., Lee J, Madbak F Eds. Dale A. Dangleben, et al.eds. ABSITE Slayer New York, NY: McGraw-Hill; . http://accesssurgery.mhmedical.com/content.aspx?bookid=2500&sectionid=201380129. Accessed November 17, 2018.
    MLA Citation
    Dangleben DA, Madbak F, Lieberman J. Dangleben D.A., Madbak F, Lieberman J Dangleben, Dale A., et al.. "Critical Care." ABSITE Slayer Dangleben DA, Lee J, Madbak F. Dangleben D.A., Lee J, Madbak F Eds. Dale A. Dangleben, et al. New York, NY: McGraw-Hill, , http://accesssurgery.mhmedical.com/content.aspx?bookid=2500&sectionid=201380129.

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TEST TAKING TIP

Test Taking Tip

Critical Care problems generally can be solved by applying physiology and pharmacology principles to the question (or patient). Understanding the sympathetic and parasympathetic nervous system assists in the diagnosis of cardiac issues and their treatment. Understanding respiratory physiology and mechanics greatly assists in solving ventilator-related questions.

HEMODYNAMIC PARAMETERS

What is the formula for mean arterial pressure (MAP)?

  • MAP = DBP + 1/3 × (SBP − DBP)

What is the normal range for cardiac output (CO)?

  • 4 to 8 L/min

What is the normal range for cardiac index (CI)?

  • 2.5 to 4 L/min

What is the normal range for systemic vascular resistance (SVR)?

  • 800 to 1400 dyn · s/(cm5)

What is the normal range for SVR index (SVRI)?

  • 1500 to 2400 dyn · s/(cm5)

What is the normal range for pulmonary capillary wedge pressure (PCWP)?

  • 7 to 15 mm Hg

What is the normal range for central venous pressure (CVP)?

  • 2 to 6 mm Hg

What is the normal range for pulmonary artery (PA) pressure?

  • 20 to 30/6 to 15 mm Hg

What is the normal range for mixed venous oxygen saturation (SvO2)?

  • 70% ± 5%

What is SvO2?

  • The oxygen saturation of blood in the right ventricle/pulmonary artery that serves as an indirect measure of peripheral oxygen supply and demand

What factors influence SvO2?

  • Oxygen delivery and oxygen extraction

Approximate percentage of CO that goes to the kidney:

  • 25%

Approximate percentage of CO that goes to the brain:

  • 15%

Approximate percentage of CO that goes to the heart:

  • 5%

INVASIVE MONITORING

What complications can occur during central venous catheter placement?

  • Arterial puncture, air or catheter embolism, dysrhythmias, hemorrhage or arteriovenous fistulization, pneumothorax, pseudoaneurysm formation

What should you immediately do if a patient receives an air embolus?

  • Roll the patient to the left and place head down to keep air in right atrium/ventricle; attempt to aspirate air with central catheter/pulmonary artery catheter

Relative contraindications for pulmonary artery catheter placement:

  • Left bundle branch block, previous pneumonectomy

Treatment for hemoptysis after pulmonary artery catheter placement:

  • Immediately pull the pulmonary artery catheter slightly back and reinflate balloon, ...

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