Hemodynamics
A Practical Application for Today’s Nurses
Contents
Begin Course Here
Earliest Recorded History: Humans recognized that breathing was synonymous with life.
History: 20th Century….
History: 21st Century to date…
Page 2
#1 Hemodynamic Concept
"Think Perfusion" is the ongoing theme of this program. The goal of all therapy is to ensure that organs are perfused.
Page 3
Pulmonary Anatomy and Physiology
Function of Pulmonary System: exchange of O2 and CO2 between the atmosphere and cells of the body.
Components Necessary for Cellular Respiration
Page 4
Cardiovascular Anatomy & Physiology
Function of the Cardiovascular System: transport of O2, nutrients, & endocrine & exocrine hormone to tissues and to carry away metabolic wastes at a rate proportionate to body needs.
Components
Page 5
Capillary Exchange
Page 6
Heart
Page 7
Hemodynamic Principles
Cardiac Cycle
Stroke Volume
Cardiac Output
Page 8
Frank-Starling Law
Frank-Starling Curve
Page 9
Preload
Correlation
Afterload
Correlation
Contractility
Page 10
SvO2/ScvO2
Page 11
Strategies to Optimize O2 Delivery
Assessment of Tissue Oxygenation
Page 12
Invasive Hemodynamics:
Invasive Monitoring Devices
Information from PA Catheter
Normal Hemodynamic Values
Core Hemodynamic Variables
Page 13
Non-Invasive Hemodynamics:
Head to Toe Assessment
Skin
Vital Signs
Phlebostatic Axis
Page 14
Head and Neck
Jugular Venous Distention
Assess Jugular Venous Distention
Pain
Page 15
Lungs
Early Warning Signs of Clinical Deterioration
Page 16
Heart
Tamponade
Pulsus Paradoxus
Auscultate Pulsus Paradoxus
Pulsus Paradoxus: Oximetry Pleth Waveform
Interventions
ECG Interpretation
Arrhythmia: AFIB
Arrhythmia: PVC's
Page 17
Abdomen
Renal/Urinary Status
Distal Circulation
Lab Values
Page 18
Pharmacologic Interventions
Affect on Principles
Page 19
Decreased Preload: Hypovolemia
Characteristics
Treatment
Page 20
Increased Preload: Hypervolemia
Characteristics
Treatment
Furosemide
Nitroglycerin
Page 21
Treatment of Decreased Afterload
Characteristics
Treatment
Adrenergic Receptors
Vasopressor Infusion Guidelines
Dopamine
Epinephrine
Norepinephrine (Levophed)
Phenylephrine (Neosynephrine)
Key Concepts
Page 22
Treatment of Increased Afterload
Characteristics
Treatment
Nitroprusside (Nipride)
ACE Inhibitors: Prevent Production of Angiotensin II
Calcium Channel Blockers
Diltiazem (Cardizem)
Beta-Adrenergic Blockers
Page 23
Decreased Contractility
Characteristics
Treatment
Contractility Enhancers
Dobutamine
Dopamine
Phosphodiesterase Inhibitors
Page 24
Case Study #1
Assessment Indications
Treatment Options
Page 25
Case Study #2
What is happening to the patient?
Page 26
Case Study #3
Condition & Treatment
Page 27
Case Study #4
Next Hour
Correlate Your Assessments
So, what is the problem?
Page 28
Case Study #5
What is the Problem?
Reminder: SvO2 Principles
Page 29
Next Steps:
Page 30
Questions:
Page 31
References
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