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ACNP I: Hemodynamics - Questions And Accurate Answers
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ACNP I: Hemodynamics - Questions And Accurate Answers
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ACNP I: Hemodynamics - Questions And AccurateAnswers
What is the best method to evaluate fluid responsiveness in the ICU/OR?
Right Ans - Stroke Volume Variation (SVV) and Pulse Pressure Variation (PPV)
related to changes in Stroke Volume (SV) during positive pressure ventilation.
For a patient who is unresponsive to fluid therapy, and SI is normal (as seen in
hyperdynamic patients with severe sepsis or septic shock-although SI may
also be increased) what may be indicated? Right Ans - SI normal-->A
Vasopressor
For a patient who is unresponsive to fluid therapy, and SI is low (low output
state: pulmonary congestion, CHF, "wet lungs") what is the appropriate
intervention? What if the patient has relatively clear lungs and/or a
reasonably low A-a gradient? Right Ans - SI low-->Inotrope or Vasodilator
therapy
Clear lungs and/or a reasonably low A-a gradient->Subsequent fluid boluses
may be adequate
For a patient who is unresponsive to fluid therapy, and SI is high (As seen in
Acute Lung Injury, ARDS, or previous massive resuscitation) what is the
appropriate intervention? Right Ans - SI high-->Diuretic therapy (to keep
lungs dry)
What is a typical goal with diuretic monitoring and volume management using
CVP and PAOP? Right Ans - CVP < 9
PAOP < 13
What is normal O2 extraction and what is considered high? Right Ans - <
33% --> low or normal
40% or greater --> high
What should be done if O2 extraction is high? Why? Right Ans - Vigorous
attempts at increasing DO2 (oxygen delivery) should be employed (such as
inotrope for perfusion support) because as O2 excretion increases,
physiologic reserve is compromised, leading to lactic acidosis and mortality
, High O2 extraction is represented by a low value of _______ and can often be
corrected with what? Right Ans - ScVO2
Improvement in O2 delivery
What is recruitable SV? Right Ans - Fluid responsiveness and improvement
in SV in patients who otherwise are not expected to be volume responsive (<
13%) by the use of challenges
Describe two recruitable SV challenges? Right Ans - 1.) Increase tidal
volume in a patient being ventilated with low tidal volume and evaluate its
impact on SVV.
2.) Passive leg raising to at least 45* for 30 seconds-several minutes to predict
fluid responsiveness. If SV improves significantly, the patient will also respond
to a volume challenge.
In acute MI, what is the first line agent for hypotension (SBP 70-100) in the
absence of shock signs/symptoms? What about with the presence of shock
signs and symptoms? If SBP is < 70, what agent would you use? Right Ans -
1.) Dobutamine
2.) Dopamine
3.) Norepinephrine (Vasopressin in norepinephrine-resistant vasodilatory
shock
The most commonly recommended initial inotropic therapy used for
refractory HF to improve CO and enhance diuresis by improving renal blood
flow and decreasing SVR without exacerbating systemic hypotension are? (3)
Right Ans - Dobutamine
Dopamine
Milrinone
What are the advantages of PA catheter use? (4) Right Ans - 1.) To establish
a diagnosis
2.) To guide therapy
3.) To monitor response to therapy
4.) To assess determinants of O2 delivery
Misuse and misinterpretation of data is a main complication of...? Right Ans
- PA catheter use
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