Maternal and Fetal Physiology
|
|
- Eunice Clark
- 5 years ago
- Views:
Transcription
1 Background Maternal and Fetal Physiology Anderson Lo, DO Fellow, Maternal-Fetal Medicine Wayne State University School of Medicine SEMCME Fetal Assessment Course July 20, 2018 Oxygen pathway Mother Placenta Fetus Interruption of the oxygen pathway may cause fetal injury What changes in maternal physiology and fetal developmental characteristics are protective against disruption of oxygen pathway? Objective Maternal physiology during pregnancy Fetal circulation Oxygen transfer between mother and fetus Fetal response to hypoxia Plasma volume Increase of 50% above nonpregnant values Begins to increase at 6-8 weeks Maximal volume ~5 L at 32 weeks Red blood cell mass Increase of 20-30% above nonpregnant values Increase by ml by term Due to increased production of red blood cells Increased maternal demand for iron (total requirement 1,000 mg) Physiologic hemodilution Increase in plasma volume > increase in RBC cell mass Decrease in hematocrit Decreased blood viscosity 1
2 Anatomic Changes Ventricular mass increases in 1 st trimester End-diastolic volume increases in the 2 nd and early 3 rd trimesters Increased cardiac compliance (physiologically dilated heart) Ejection fraction maintained due to increased contractility Cardiac output Cardiac output a measure of the functional capacity of the heart Cardiac output = HR x SV Cardiac output is increased in pregnancy Increases by 30-50% From 4.5 L/min to 6 L/min Earliest rise in CO is due to increase in SV Gradual increase in maternal HR Netter Cardiac output is affected by maternal position Supine hypotension syndrome Compression of IVC decreased venous return 25-30% fall in CO Manifested by: Sudden drop in BP Bradycardia Syncope Distribution of Cardiac Output Percentage of cardiac output to the uterus Non-pregnant state: 2% Pregnancy: 20% by term ( ml/min) Increased blood flow to Kidneys (increases by 50%) Skin Breasts Gray, Henry. Anatomy of the Human Body Blood Pressure Decrease in peripheral vascular resistance from increased cardiac output Arterial blood pressure decreases in pregnancy as early as 7 weeks Nadir occurs from weeks Followed by rise toward nonpregnant values at term Hemodynamic Changes in Labor 1 st Stage 2 nd Stage Postpartum ~10-30% increase in CO ~50% increase in CO 80% increase in CO within 15 minutes after Due to increase in SV Some related to pain vaginal delivery Uterine contractions transfer blood from uterus to general circulation Release of venacaval obstruction Autotransfusion of uteroplacental blood Rapid mobilization of extravascular fluid 2
3 Review Maternal Lungs Change in pregnancy Plasma volume Red blood cell mass Cardiac output Heart rate Stroke volume Peripheral vascular resistance Ejection fraction Increase in subcostal angle and chest circumference Upward displacement of diaphragm Hegewald, M.J. Clin Chest Med Pulmonary Function Minute ventilation is increased in pregnancy Increased TV Decreased ERV RV No change IRV Minute ventilation (MV) volume of air that can be inhaled or exhaled during 1 minute MV = TV x RR Increase MV (30-50%) attributed to increase in TV alone Mild respiratory alkalosis is normal in pregnancy PaCO2 Serum bicarbonate Pre-pregnancy ~39 mmhg meq/l Pregnancy ~30 mmhg (at term) meq/l 3
4 Fetal Circulation 3 shunts Preferential streaming Distribution of cardiac output 65% of cardiac output from RV 35% of cardiac output from LV O2 transport from mother to the fetus Facilitated by Higher affinity of fetal hemoglobin for oxygen Difference in oxygen concentration gradient between maternal and fetal blood Bohr effect Fetal hemoglobin has higher oxygen affinity than adult hemoglobin Both CO2 and O2 move down their concentration gradient Bohr Effect Fetus responds to hypoxia by increasing blood flow to CNS and heart Limit of circulatory defense against hypoxia is reached when perfusion rate of CNS and heart has reached its maximum Respiratory acidosis = acute compromise (reflected in PCO2 in umbilical vessels) Metabolic acidosis = prolonged compromise (reflected in base deficit in umbilical vessels) 4
5 Definitions Hypoxemia decreased O2 in blood Hypoxia decreased O2 in tissue Acidemia increased hydrogen ions in blood Acidosis increased hydrogen ions in tissue Asphyxia hypoxia with metabolic acidosis Perinatal asphyxia Implies hypoxia to a degree leading to metabolic acidosis Apgar score is not a good tool to measure asphyxia Umbilical artery blood ph < 7.0 Base deficit > 12 meq/l Thank You 5
FHR Monitoring: Maternal Fetal Physiology
FHR Monitoring: Maternal Fetal Physiology M. Sean Esplin, MD and Alexandra Eller, MD Maternal Fetal Medicine Intermountain Healthcare University of Utah Health Sciences Center Disclosures I have no financial
More informationMaternal Cardiac Disease In Pregnancy. August 25, 2017 PREGNANCY ECHO CONFERENCE
Maternal Cardiac Disease In Pregnancy August 25, 2017 PREGNANCY ECHO CONFERENCE Maternal Physiology Cardiac Output = HR x SV Non-pregnant: 4.5 L/min Pregnant: 6.0 L/min Increase most acute in first 10
More informationShock is defined as a state of cellular and tissue hypoxia due to : reduced oxygen delivery and/or increased oxygen consumption or inadequate oxygen
Shock is defined as a state of cellular and tissue hypoxia due to : reduced oxygen delivery and/or increased oxygen consumption or inadequate oxygen utilization The effects of shock are initially reversible
More informationWeeks 1-3:Cardiovascular
Weeks 1-3:Cardiovascular Cardiac Output The total volume of blood ejected from the ventricles in one minute is known as the cardiac output. Heart Rate (HR) X Stroke Volume (SV) = Cardiac Output Normal
More information3. Which of the following would be inconsistent with respiratory alkalosis? A. ph = 7.57 B. PaCO = 30 mm Hg C. ph = 7.63 D.
Pilbeam: Mechanical Ventilation, 4 th Edition Test Bank Chapter 1: Oxygenation and Acid-Base Evaluation MULTIPLE CHOICE 1. The diffusion of carbon dioxide across the alveolar capillary membrane is. A.
More informationPregnancy and Heart Disease Sharon L. Roble, MD Echo Hawaii 2016
1 Pregnancy and Heart Disease Sharon L. Roble, MD Echo Hawaii 2016 DISCLOSURES I have no disclosures relevant to today s talk 2 Cardiovascular Effects of Pregnancy Anatomic Ventricular muscle mass increases
More informationHemodynamic Changes in Obstetric Anesthesia. Sonia Vaida PANA, Hershey, April 2009
Hemodynamic Changes in Obstetric Anesthesia Sonia Vaida PANA, Hershey, April 2009 Pregnancy is a normal healthy condition and is simultaneously the most common altered physiologic state to which human
More informationA simple case of.. Acute severe asthma. MasterclassIC Schiermonnikoog 2017
A simple case of.. Acute severe asthma MasterclassIC Schiermonnikoog 2017 Case (1) Female, 27 - G1P0 (26 weeks) PMH - several admissions for severe acute asthma (no MV) Progressive dyspnea for 1 week Admitted
More informationExam KEY. NROSCI/BIOSC 1070 and MSNBIO 2070 Exam # 2 October 23, 2015 Total POINTS: % of grade in class
NROSCI/BIOSC 1070 and MSNBIO 2070 Exam # 2 October 23, 2015 Total POINTS: 100 20% of grade in class 1) Arterial and venous blood samples are taken, and other physiological measures are obtained, from a
More informationChapter 9, Part 2. Cardiocirculatory Adjustments to Exercise
Chapter 9, Part 2 Cardiocirculatory Adjustments to Exercise Electrical Activity of the Heart Contraction of the heart depends on electrical stimulation of the myocardium Impulse is initiated in the right
More informationChronic Obstructive Pulmonary Disease
136 PHYSIOLOGY CASES AND PROBLEMS Case 24 Chronic Obstructive Pulmonary Disease Bernice Betweiler is a 73-year-old retired seamstress who has never been married. She worked in the alterations department
More informationA Challenging Case: Von Willebrand Disease and Pulmonary Hypertension in Pregnancy
A Challenging Case: Von Willebrand Disease and Pulmonary Hypertension in Pregnancy Diana S. Wolfe, MD, MPH Assistant Professor Department of Obstetrics & Gynecology and Women s Health Associate Fellowship
More informationOXYGENATION AND ACID- BASE EVALUATION. Chapter 1
OXYGENATION AND ACID- BASE EVALUATION Chapter 1 MECHANICAL VENTILATION Used when patients are unable to sustain the level of ventilation necessary to maintain the gas exchange functions Artificial support
More informationModule G: Oxygen Transport. Oxygen Transport. Dissolved Oxygen. Combined Oxygen. Topics to Cover
Topics to Cover Module G: Oxygen Transport Oxygen Transport Oxygen Dissociation Curve Oxygen Transport Studies Tissue Hypoxia Cyanosis Polycythemia Oxygen Transport Oxygen is carried from the lungs to
More informationGUIDELINE PHYSIOLOGY OF BIRTH ASPHYXIA
GUIDELINE PHYSIOLOGY OF BIRTH ASPHYXIA The newborn is not an adult, nor a child. In people of all ages, death can occur from a failure of breathing and / or circulation. The interventions required to aid
More information3. Which statement is false about anatomical dead space?
Respiratory MCQs 1. Which of these statements is correct? a. Regular bronchioles are the most distal part of the respiratory tract to contain glands. b. Larynx do contain significant amounts of smooth
More informationSESSION D5. The Heart of the Matter: Cardiac Disease in Pregnancy Brad M. Dolinsky, MD, MFM
37th Annual Advanced Practice in Primary and Acute Care Conference: October 9-11, 2014 2:45 SESSION D5 Session Description: The Heart of the Matter: Cardiac Disease in Pregnancy Brad M. Dolinsky, MD, MFM
More informationCritical Care Monitoring. Assessing the Adequacy of Tissue Oxygenation. Tissue Oxygenation - Step 1. Tissue Oxygenation
Critical Care Monitoring 1 Assessing the Adequacy of Tissue oxygenation is the end-product of many complex steps 2 - Step 1 Oxygen must be made available to alveoli 3 1 - Step 2 Oxygen must cross the alveolarcapillary
More informationIntroduction. Invasive Hemodynamic Monitoring. Determinants of Cardiovascular Function. Cardiovascular System. Hemodynamic Monitoring
Introduction Invasive Hemodynamic Monitoring Audis Bethea, Pharm.D. Assistant Professor Therapeutics IV January 21, 2004 Hemodynamic monitoring is necessary to assess and manage shock Information obtained
More informationMechanical Ventilation. Assessing the Adequacy of Tissue Oxygenation. Tissue Oxygenation - Step 1. Tissue Oxygenation
1 Mechanical Ventilation Assessing the Adequacy of 2 Tissue oxygenation is the end-product of many complex steps - Step 1 3 Oxygen must be made available to alveoli 1 - Step 2 4 Oxygen must cross the alveolarcapillary
More informationPREGNANCY AND CONGENITAL HEART DISEASE
PREGNANCY AND CONGENITAL HEART DISEASE SIDDHARTH JADHAV M.D. Assistant Professor of Radiology E.B. Singleton Department of Pediatric Radiology Texas Children's Hospital COMMERCIAL DISCLOSURE - None Objectives
More informationACUTE RESPIRATORY DISTRESS SYNDROME (ARDS) Rv
ACUTE RESPIRATORY DISTRESS SYNDROME (ARDS) Rv.8.18.18 ACUTE RESPIRATORY DISTRESS SYNDROME (ARDS) SUDDEN PROGRESSIVE FORM OF ACUTE RESPIRATORY FAILURE ALVEOLAR CAPILLARY MEMBRANE BECOMES DAMAGED AND MORE
More informationLecture 10. Circulatory systems; flow dynamics, flow regulation in response to environmental and internal conditions.
Lecture 10 Circulatory systems; flow dynamics, flow regulation in response to environmental and internal conditions Professor Simchon Influence of P O2 on Hemoglobin Saturation Hemoglobin saturation plotted
More informationPHYSIOLOGY MeQ'S (Morgan) All the following statements related to blood volume are correct except for: 5 A. Blood volume is about 5 litres. B.
PHYSIOLOGY MeQ'S (Morgan) Chapter 5 All the following statements related to capillary Starling's forces are correct except for: 1 A. Hydrostatic pressure at arterial end is greater than at venous end.
More informationCor pulmonale. Dr hamid reza javadi
1 Cor pulmonale Dr hamid reza javadi 2 Definition Cor pulmonale ;pulmonary heart disease; is defined as dilation and hypertrophy of the right ventricle (RV) in response to diseases of the pulmonary vasculature
More informationPhysiologic Based Management of Circulatory Shock Kuwait 2018
Physiologic Based Management of Circulatory Shock Kuwait 2018 Dr. Yasser Elsayed, MD, PhD Director of the Targeted Neonatal Echocardiography, Point of Care and Hemodynamics Program Staff Neonatologist
More informationObjective 2/9/2012. Blood Gas Analysis In The Univentricular Patient: The Need For A Different Perspective. VENOARTERIAL CO2 GRADIENT
Blood Gas Analysis In The Univentricular Patient: The Need For A Different Perspective. Gary Grist RN CCP Chief Perfusionist The Children s Mercy Hospitals and Clinics Kansas City, Mo. Objective The participant
More information4/19/2018. St. Cloud Hospital Perinatology Kristin Olson, RDMS, RVT
St. Cloud Hospital Perinatology Kristin Olson, RDMS, RVT Review Fetal Circulation Provide Indications for Umbilical Artery, Middle Cerebral Artery, and Ductus Venosus Doppler studies. Demonstrate normal
More information3 European Journal of Heart Failure 2016; 18,
Impella Assisted Cesarean Delivery in a 27 6/7 Weeks Gestation 30 Year Old Female with Newly Diagnosed Cardiomyopathy & Multifocal Incessant Ventricular Tachycardia Brendan J Carry, MD, Jason Costa, MD,
More informationAdvanced Monitoring of Cardiovascular and Respiratory Systems in Infants Kuwait 2018 Dr. Yasser Elsayed, MD, PhD Director of the Targeted Neonatal
Advanced Monitoring of Cardiovascular and Respiratory Systems in Infants Kuwait 2018 Dr. Yasser Elsayed, MD, PhD Director of the Targeted Neonatal Echocardiography, Point of Care and Hemodynamics Program
More informationTopics to be Covered. Cardiac Measurements. Distribution of Blood Volume. Distribution of Pulmonary Ventilation & Blood Flow
Topics to be Covered MODULE F HEMODYNAMIC MONITORING Cardiac Output Determinants of Stroke Volume Hemodynamic Measurements Pulmonary Artery Catheterization Control of Blood Pressure Heart Failure Cardiac
More informationi. Zone 1 = dead space ii. Zone 2 = ventilation = perfusion (ideal situation) iii. Zone 3 = shunt
Respiratory Review I. Oxygen transport a. Oxygen content of blood i. Dissolved oxygen =.003 x PaO 2, per 100 ml plasma 1. Henry s Law ii. Oxygen on hemoglobin = 1.34 ml x sat x Hgb iii. CaO 2 = Dissolved
More informationValve Disease in the Pregnant Patient
Valve Disease in the Pregnant Patient Julie B. Damp, MD December 6, 2012 VanderbiltHeart.com If single, do not allow marriage. If fertile, do not allow pregnancy. If pregnant, do not allow delivery. If
More informationHyaline membrane disease. By : Dr. Ch Sarishma Peadiatric Pg
Hyaline membrane disease By : Dr. Ch Sarishma Peadiatric Pg Also called Respiratory distress syndrome. It occurs primarily in premature infants; its incidence is inversely related to gestational age and
More informationFUNDAMENTALS OF HEMODYNAMICS, VASOACTIVE DRUGS AND IABP IN THE FAILING HEART
FUNDAMENTALS OF HEMODYNAMICS, VASOACTIVE DRUGS AND IABP IN THE FAILING HEART CINDY BITHER, MSN, ANP, ANP, AACC, CHFN CHIEF NP, ADV HF PROGRAM MEDSTAR WASHINGTON HOSPITAL CENTER CONFLICTS OF INTEREST NONE
More informationDr. Puntarica Suwanprathes. Version 2007
Dr. Puntarica Suwanprathes Version 2007 O 2 and CO 2 transport in blood Oxyhemoglobin dissociation curve O 2 consumption (VO 2 ) CO 2 production (VCO 2 ) O 2 capacity O 2 content: CaO 2 or CvO 2 %saturation
More informationAcid-Base Imbalance. Shu-Yi (Emily) Wang, PhD, RN, CNS Denver School of Nursing
Acid-Base Imbalance Shu-Yi (Emily) Wang, PhD, RN, CNS gpwsy@hotmail.com Denver School of Nursing ph Ranges Compatible With Life In blood, the ph represents the relationship between the respiratory and
More informationAcid/Base Disorders 2015
Objectives - 2 1. Identify acid/base disorders 2. Discuss etiologies for 1 0 acid/base disorders (will not include mixed disorders) 3. Interpret acid/base disorders by interpreting arterial blood gas &
More informationCardiac Output MCQ. Professor of Cardiovascular Physiology. Cairo University 2007
Cardiac Output MCQ Abdel Moniem Ibrahim Ahmed, MD Professor of Cardiovascular Physiology Cairo University 2007 90- Guided by Ohm's law when : a- Cardiac output = 5.6 L/min. b- Systolic and diastolic BP
More informationCOPYRIGHTED MATERIAL. The fetal circulation CHAPTER 1. Postnatal circulation
1 CHAPTER 1 The fetal circulation The circulation in the fetus differs from that in the adult. Knowledge of the course and distribution of the fetal circulation is important to our understanding of the
More informationHOW LOW CAN YOU GO? HYPOTENSION AND THE ANESTHETIZED PATIENT.
HOW LOW CAN YOU GO? HYPOTENSION AND THE ANESTHETIZED PATIENT. Donna M. Sisak, CVT, LVT, VTS (Anesthesia/Analgesia) Seattle Veterinary Specialists Kirkland, WA dsisak@svsvet.com THE ANESTHETIZED PATIENT
More informationCarbon Dioxide Transport. Carbon Dioxide. Carbon Dioxide Transport. Carbon Dioxide Transport - Plasma. Hydrolysis of Water
Module H: Carbon Dioxide Transport Beachey Ch 9 & 10 Egan pp. 244-246, 281-284 Carbon Dioxide Transport At the end of today s session you will be able to : Describe the relationship free hydrogen ions
More informationEjection across stenotic aortic valve requires a systolic pressure gradient between the LV and aorta. This places a pressure load on the LV.
Valvular Heart Disease Etiology General Principles Cellular and molecular mechanism of valve damage Structural pathology Functional pathology - stenosis/regurgitation Loading conditions - pressure/volume
More informationNothing to Disclose. Severe Pulmonary Hypertension
Severe Ronald Pearl, MD, PhD Professor and Chair Department of Anesthesiology Stanford University Rpearl@stanford.edu Nothing to Disclose 65 year old female Elective knee surgery NYHA Class 3 Aortic stenosis
More informationBUFFERING OF HYDROGEN LOAD
BUFFERING OF HYDROGEN LOAD 1. Extracellular space minutes 2. Intracellular space minutes to hours 3. Respiratory compensation 6 to 12 hours 4. Renal compensation hours, up to 2-3 days RENAL HYDROGEN SECRETION
More information1
1 2 3 RIFAI 5 6 Dublin cohort, retrospective review. Milrinone was commenced at an initial dose of 0.50 μg/kg/minute up to 0.75 μg/kg/minute and was continued depending on clinical response. No loading
More informationAcid-base and Blood Gases in the Fetus
Acid-base and Blood Gases in the Fetus J T Parer, MD, PhD Maternal Fatal Medicine University of California San Francisco 40 th Meeting Antepartum and Intrapartum Management San Francisco, California June,
More informationEjection across stenotic aortic valve requires a systolic pressure gradient between the LV and aorta. This places a pressure load on the LV.
Valvular Heart Disease General Principles Etiology Cellular and molecular mechanism of valve damage Structural pathology Functional pathology - stenosis/regurgitation Loading conditions - pressure/volume
More informationCase discussion Acute severe asthma during pregnancy. J.G. van der Hoeven
Case discussion Acute severe asthma during pregnancy J.G. van der Hoeven Case (1) 32-year-old female - gravida 3 - para 2 Previous medical history - asthma Pregnant (33 w) Acute onset fever with wheezing
More informationCARDIOVASCULAR SYSTEM
CARDIOVASCULAR SYSTEM 1. Resting membrane potential of the ventricular myocardium is: A. -55 to-65mv B. --65 to-75mv C. -75 to-85mv D. -85 to-95 mv E. -95 to-105mv 2. Regarding myocardial contraction:
More informationThe Anatomy and Physiology of the Circulatory System
CHAPTER 5 The Anatomy and Physiology of the Circulatory System The Circulatory System Blood Heart Vascular System THE BLOOD Formed Elements of Blood Table 5-1 Cell Type Erythrocytes (Red Blood Cells, RBCs)
More informationRV dysfunction and failure PATHOPHYSIOLOGY. Adam Torbicki MD, Dept Chest Medicine Institute of Tuberculosis and Lung Diseases Warszawa, Poland
RV dysfunction and failure PATHOPHYSIOLOGY Adam Torbicki MD, Dept Chest Medicine Institute of Tuberculosis and Lung Diseases Warszawa, Poland Normal Right Ventricle (RV) Thinner wall Weaker myocytes Differences
More informationNeonatal Resuscitation. Dustin Coyle, M.D. Anesthesiology
Neonatal Resuscitation Dustin Coyle, M.D. Anesthesiology Recognize complications Maternal-fetal factors Maternal DM PIH Chronic HTN Previous stillbirth Rh sensitization Infection Substance abuse/certain
More informationThe Cardiovascular System. The Structure of Blood Vessels. The Structure of Blood Vessels. The Blood Vessels. Blood Vessel Review
The Cardiovascular System The Blood Vessels The Structure of Blood Vessels Blood Vessel Review Arteries carry blood away from the heart Pulmonary trunk to lungs Aorta to everything else Microcirculation
More informationCardiac Output (C.O.) Regulation of Cardiac Output
Cardiac Output (C.O.) Is the volume of the blood pumped by each ventricle per minute (5 Litre) Stroke volume: Is the volume of the blood pumped by each ventricle per beat. Stroke volume = End diastolic
More informationEffects of mechanical ventilation on organ function. Masterclass ICU nurses
Effects of mechanical ventilation on organ function Masterclass ICU nurses Case Male, 60 - No PMH - L 1.74 m and W 85 kg Pneumococcal pneumonia Stable hemodynamics - No AKI MV in prone position (PEEP 16
More informationBiology 236 Spring 2002 Campos/Wurdak/Fahey Laboratory 4. Cardiovascular and Respiratory Adjustments to Stationary Bicycle Exercise.
BACKGROUND: Cardiovascular and Respiratory Adjustments to Stationary Bicycle Exercise. The integration of cardiovascular and respiratory adjustments occurring in response to varying levels of metabolic
More informationcardiac imaging planes planning basic cardiac & aortic views for MR
cardiac imaging planes planning basic cardiac & aortic views for MR Dianna M. E. Bardo, M. D. Assistant Professor of Radiology & Cardiovascular Medicine Director of Cardiac Imaging cardiac imaging planes
More informationDepartment of Intensive Care Medicine UNDERSTANDING CIRCULATORY FAILURE IN SEPSIS
Department of Intensive Care Medicine UNDERSTANDING CIRCULATORY FAILURE IN SEPSIS UNDERSTANDING CIRCULATORY FAILURE IN SEPSIS a mismatch between tissue perfusion and metabolic demands the heart, the vasculature
More informationINTRODUCTION The effect of CPAP works on lung mechanics to improve oxygenation (PaO 2
2 Effects of CPAP INTRODUCTION The effect of CPAP works on lung mechanics to improve oxygenation (PaO 2 ). The effect on CO 2 is only secondary to the primary process of improvement in lung volume and
More informationPrinciples of Biomedical Systems & Devices. Lecture 8: Cardiovascular Dynamics Dr. Maria Tahamont
Principles of Biomedical Systems & Devices Lecture 8: Cardiovascular Dynamics Dr. Maria Tahamont Review of Cardiac Anatomy Four chambers Two atria-receive blood from the vena cave and pulmonary veins Two
More information2/4/2011. Nathan Kerner, M.D.
Nathan Kerner, M.D. Definition Elevated pressures - cut off usually >40 mmhg pulmonary artery systolic pressure (PASP) Usually associated with elevated pulmonary vascular resistance (PVR) measured in dynessec/cm
More informationChapter 21. Flail Chest. Mosby items and derived items 2011, 2006 by Mosby, Inc., an affiliate of Elsevier Inc.
Chapter 21 Flail Chest 1 Figure 21-1. Flail chest. Double fractures of three or more adjacent ribs produce instability of the chest wall and paradoxical motion of the thorax. Inset, Atelectasis, a common
More informationInterpretation of Arterial Blood Gases. Prof. Dr. W. Vincken Head Respiratory Division Academisch Ziekenhuis Vrije Universiteit Brussel (AZ VUB)
Interpretation of Arterial Blood Gases Prof. Dr. W. Vincken Head Respiratory Division Academisch Ziekenhuis Vrije Universiteit Brussel (AZ VUB) Before interpretation of ABG Make/Take note of Correct puncture
More informationEnergy sources in skeletal muscle
Energy sources in skeletal muscle Pathway Rate Extent ATP/glucose 1. Direct phosphorylation Extremely fast Very limited - 2. Glycolisis Very fast limited 2-3 3. Oxidative phosphorylation Slow Unlimited
More informationWhen is Risky to Apply Oxygen for Congenital Heart Disease 부천세종병원 소아청소년과최은영
When is Risky to Apply Oxygen for Congenital Heart Disease 부천세종병원 소아청소년과최은영 The Korean Society of Cardiology COI Disclosure Eun-Young Choi The author have no financial conflicts of interest to disclose
More informationMaternal Physiology and the Anesthetized Pregnant Patient. Kimberly Babiash, MD, MBA Oct 7, 2015
Maternal Physiology and the Anesthetized Pregnant Patient Kimberly Babiash, MD, MBA Oct 7, 2015 Overview Neuraxial Anesthesia Epidurals vs spinals How they work Physiologic alterations Contraindications
More informationManaging Compromised and Weak Calves at Birth
University of Nebraska - Lincoln DigitalCommons@University of Nebraska - Lincoln Range Beef Cow Symposium Animal Science Department 11-2015 Managing Compromised and Weak Calves at Birth Franklyn Garry
More informationChapter 14 Blood Vessels, Blood Flow and Pressure Exam Study Questions
Chapter 14 Blood Vessels, Blood Flow and Pressure Exam Study Questions 14.1 Physical Law Governing Blood Flow and Blood Pressure 1. How do you calculate flow rate? 2. What is the driving force of blood
More informationRespiratory Pathophysiology Cases Linda Costanzo Ph.D.
Respiratory Pathophysiology Cases Linda Costanzo Ph.D. I. Case of Pulmonary Fibrosis Susan was diagnosed 3 years ago with diffuse interstitial pulmonary fibrosis. She tries to continue normal activities,
More informationPulmonary circulation. Lung Blood supply : lungs have a unique blood supply system :
Dr. Ali Naji Pulmonary circulation Lung Blood supply : lungs have a unique blood supply system : 1. Pulmonary circulation 2. Bronchial circulation 1- Pulmonary circulation : receives the whole cardiac
More informationCASE DISCUSSION. Dr JAYASREE VEERABOINA 2nd yr PG MS OBG
CASE DISCUSSION Dr JAYASREE VEERABOINA 2nd yr PG MS OBG Normal Cardiovascular changes in Pregnancy CARDIAC OUTPUT 5 th wk -- starts 12 wks -- 30-35% 30-32 wks -- 40% During labour -- 50% After delivery
More informationPIAF study: Placental insufficiency and aortic isthmus flow Jean-Claude Fouron, MD
Dear colleagues, I would like to thank you very sincerely for agreeing to participate in our multicentre study on the clinical significance of recording fetal aortic isthmus flow during placental circulatory
More informationPulmonary Problems of the Neonate. Jon Palmer, VMD, DACVIM Chief, Neonatal Intensive Care Service New Bolton Center, University of Pennsylvania, USA
Pulmonary Problems of the Neonate Jon Palmer, VMD, DACVIM Chief, Neonatal Intensive Care Service New Bolton Center, University of Pennsylvania, USA Lower Respiratory Diseases Ventilation/Perfusion Abnormalities
More informationSkeletal muscle. Flow increases and decreases with each muscular contraction - as a result of compression of the blood vessels by contracted muscle
Regional blood flow Skeletal muscle Extreme increases during exercises Flow increases and decreases with each muscular contraction - as a result of compression of the blood vessels by contracted muscle
More informationChapter 9. Body Fluid Compartments. Body Fluid Compartments. Blood Volume. Blood Volume. Viscosity. Circulatory Adaptations to Exercise Part 4
Body Fluid Compartments Chapter 9 Circulatory Adaptations to Exercise Part 4 Total body fluids (40 L) Intracellular fluid (ICF) 25 L Fluid of each cell (75 trillion) Constituents inside cell vary Extracellular
More informationPerformance Enhancement. Cardiovascular/Respiratory Systems and Athletic Performance
Performance Enhancement Cardiovascular/Respiratory Systems and Athletic Performance Functions of the Cardiovascular System Deliver oxygen & nutrients to body tissues Carry wastes from the cells Anatomy
More informationThe Role of the Anaesthesiologist in the Perioperative Management of Preeclampsia. RA Dyer Interlaken 2017
The Role of the Anaesthesiologist in the Perioperative Management of Preeclampsia RA Dyer Interlaken 2017 6 In preeclampsia - Understanding of pathophysiology Assessment of disease severity Prediction
More informationHeart Pump and Cardiac Cycle. Faisal I. Mohammed, MD, PhD
Heart Pump and Cardiac Cycle Faisal I. Mohammed, MD, PhD 1 Objectives To understand the volume, mechanical, pressure and electrical changes during the cardiac cycle To understand the inter-relationship
More informationAnatomy & Physiology
1 Anatomy & Physiology Heart is divided into four chambers, two atrias & two ventricles. Atrioventricular valves (tricuspid & mitral) separate the atria from ventricles. they open & close to control flow
More informationCirculation: Chapter 25. Cardiac Output. The Mammalian Heart Fig Right side of the heart
Circulation: Chapter 25 1. Limits of Diffusion A. Small organisms use diffusion B. rapid over small distances 2. Most animals have circulatory systems A. Blood B. Pump (Heart) or propulsive structures
More informationUNIT VI: ACID BASE IMBALANCE
UNIT VI: ACID BASE IMBALANCE 1 Objectives: Review the physiological mechanism responsible to regulate acid base balance in the body i.e.: Buffers (phosphate, hemoglobin, carbonate) Renal mechanism Respiratory
More informationCardiac output and Venous Return. Faisal I. Mohammed, MD, PhD
Cardiac output and Venous Return Faisal I. Mohammed, MD, PhD 1 Objectives Define cardiac output and venous return Describe the methods of measurement of CO Outline the factors that regulate cardiac output
More information-Cardiogenic: shock state resulting from impairment or failure of myocardium
Shock chapter Shock -Condition in which tissue perfusion is inadequate to deliver oxygen, nutrients to support vital organs, cellular function -Affects all body systems -Classic signs of early shock: Tachycardia,tachypnea,restlessness,anxiety,
More informationAcid and Base Balance
Acid and Base Balance 1 2 The Body and ph Homeostasis of ph is tightly controlled Extracellular fluid = 7.4 Blood = 7.35 7.45 < 7.35: Acidosis (acidemia) > 7.45: Alkalosis (alkalemia) < 6.8 or > 8.0: death
More informationSymBioSys Exercise 2 Cardiac Function Revised and reformatted by C. S. Tritt, Ph.D. Last updated March 20, 2006
SymBioSys Exercise 2 Cardiac Function Revised and reformatted by C. S. Tritt, Ph.D. Last updated March 20, 2006 The goal of this exercise to explore the behavior of the heart as a mechanical pump. For
More informationCongenital Heart Disease Patient and Pregnancy
Congenital Heart Disease Patient and Pregnancy Gurur Biliciler-Denktas, M.D. Assistant Professor Division of Pediatric Cardiology, Department of Pediatrics The University of Texas Health Science Center
More informationHemodynamic Monitoring
Perform Procedure And Interpret Results Hemodynamic Monitoring Tracheal Tube Cuff Pressure Dean R. Hess PhD RRT FAARC Hemodynamic Monitoring Cardiac Rate and Rhythm Arterial Blood Pressure Central Venous
More informationFirst Trimester Fetal Echocardiography: Insight Into the Fetal Circulation
First Trimester Fetal Echocardiography: Insight Into the Fetal Circulation Lisa K. Hornberger, MD Fetal & Neonatal Cardiology Program Department of Pediatrics, Division of Cardiology Department of Obstetrics
More informationCONTEMPORARY APPROACH PULMONARY HYPERTENSION IN PREGNANCY
CONTEMPORARY APPROACH PULMONARY HYPERTENSION IN PREGNANCY Dianne L. Zwicke, MD Clinical Adjunct Professor of Medicine University of Wisconsin School of Medicine and Public Health Medical Director, Pulmonary
More informationOmar Sami. Mustafa Khader. Yanal Shafaqouj
8 Omar Sami Mustafa Khader Yanal Shafaqouj Let us retrieve our discussion about the ventilation-perfusion ratio (V/Q). - When (V/Q) is Zero this means that no ventilation is taking place, V is Zero; bronchial
More informationArterial Blood Gases. Dr Mark Young Mater Health Services
Arterial Blood Gases Dr Mark Young Mater Health Services Why do them? Quick results Bedside test Range of important information Oxygenation Effectiveness of gas exchange Control of ventilation Acid base
More informationAssessment of fetal heart function and rhythm
Assessment of fetal heart function and rhythm The fetal myocardium Early Gestation Myofibrils 30% of myocytes Less sarcoplasmic reticula Late Gestation Myofibrils 60% of myocytes Increased force per unit
More informationHeart Failure. Cardiac Anatomy. Functions of the Heart. Cardiac Cycle/Hemodynamics. Determinants of Cardiac Output. Cardiac Output
Cardiac Anatomy Heart Failure Professor Qing ZHANG Department of Cardiology, West China Hospital www.blaufuss.org Cardiac Cycle/Hemodynamics Functions of the Heart Essential functions of the heart to cover
More informationIntroduction and Overview of Acute Respiratory Failure
Introduction and Overview of Acute Respiratory Failure Definition: Acute Respiratory Failure Failure to oxygenate Inadequate PaO 2 to saturate hemoglobin PaO 2 of 60 mm Hg ~ SaO 2 of 90% PaO 2 of 50 mm
More informationPathophysiology: Left To Right Shunts
Pathophysiology: Left To Right Shunts Daphne T. Hsu, MD dh17@columbia.edu Learning Objectives Learn the relationships between pressure, blood flow, and resistance Review the transition from fetal to mature
More informationChapter 42: Circulation / Gas Exchange. d = t 2
Chapter 42: Circulation / Gas Exchange Transport systems connect organs of exchange with body cells Diffusion Lung Blood 100 m 1 s 1 mm 100 s 1 cm 10000 s d = t 2 Bulk Flow (Pressure) Blood Cells Methods
More informationHemodynamics of Exercise
Hemodynamics of Exercise Joe M. Moody, Jr, MD UTHSCSA and ALMMVAH, STVAHCS Exercise Physiology - Acute Effects Cardiac Output (Stroke volume, Heart Rate ) Oxygen Extraction (Arteriovenous O 2 difference,
More informationRESPIRATORY FAILURE. Michael Kelly, MD Division of Pediatric Critical Care Dept. of Pediatrics
RESPIRATORY FAILURE Michael Kelly, MD Division of Pediatric Critical Care Dept. of Pediatrics What talk is he giving? DO2= CO * CaO2 CO = HR * SV CaO2 = (Hgb* SaO2 * 1.34) + (PaO2 * 0.003) Sound familiar??
More information