Fluids: occult effects. S Magder Department of Critical Care, McGill University Health Centre
|
|
- Reynard Goodman
- 6 years ago
- Views:
Transcription
1 Fluids: occult effects S Magder Department of Critical Care, McGill University Health Centre
2
3 Why is volume important? 1. Water is essential to dissolve substances and allow them to diffuse 2. Necessary for bulk flow
4 What does volume do?
5 Volume creates venous elastic recoil force Q = Determinants of flow Stressed Volume Cv x Rv Rv Increase the initial volume Greater flow Cv Stressed volume
6 Heart has a restorative function which refills the veins Volume stretches the veins and creates the recoil pressure that drives flow back to the heart Heart has a permissive function. It lowers the outflow pressure and allows veins to empty
7 Fluid Challenge 1 Assess the value of Pra ( NOT the wedge). Q -ve 2 Give sufficient fluid to raise Pra by ~2mmHg and observe Q. +ve Pra Type of fluid is not of importance if given fast enough
8 Change in CVP of even 1 mmhg should be sufficient to test the Starling response Q (l/min) plateau 5 Slope = 500 ml/min/mmhg 0 10 Pra (mmhg)
9 Non-volume effects +ve 1. Reserves Interstitial unstressed 2. Restore perfusion 3. Non-volume effects Albumin Starch Even saline 1. Filtration -ve 2. Distort the RV 3. Wound healing 4. Liver/renal failure 5. Dilution ScvO 2 Hb INR 6. SID
10 Concept of Stressed and Unstressed Volume SFP MSFP Unstressed volume Unstressed volume provides a reserve that can increase stressed volume Acts like an auto-transfusion Therefore reserves are important
11 MSFP (mmhg) MSFP (mmhg) Change in Capacitance (can recruit ml /kg of unstressed into stressed volume) MCFP (mmhg) MCFP (mmhg) Volume (ml) Volume (ml)
12 Change in Capacitance P MSFP MSFP Q V MSFP MCFP Q MSFP Pra But this volume Can recruit must be restored ~ 10 ml/kg of to provide unstressed to reserves for stressed future needs
13 Importance of interstitial volume 35% 65% 5 L Interstitial IC Provides another important reserve in the system which allows adaption to volume loss
14 Normal Saline in Patient with Large Extra-cellular Volume IC Interstitial IC EC EC The rule that saline distribution is 1/3 vascular 2/3 interstitial is no longer true
15 Non-volume effect of hyperoncotic solution (Albumin 25%, 100 ml) Patients day 1 following cardiac surgery Treating team thought that a fluid bolus would improve cardiac output Patients were 3-5 L positive. Magder & Lagonidis. JCCM 14:164, 1999
16 Albumin vs Saline to Test Volume Responsiveness Pra Cardiac Output delta Pra (mmhg) * * p= ALBUMIN SALINE delta CI (l/min/m 2 ) * p=0.043 ALBUMIN SALINE Magder & Lagonidis. JCCM 14:164, 1999
17 How can cardiac output rise without a rise in Pra? Q Function change It implies a change in both circuit & cardiac function. Volume effect Pra
18 Restore normal perfusion? Restoring cardiac output to normal and improving circulation could turn of cytokine and acute phase response and result in circulatory stabilization.
19 -ve aspects of fluids
20 Starling s Forces Volume increases filtration Pout out Pin in If dialysis can remove 3-4 L without hemodynamic consequences you can loose it into the interstitial space just as fast!
21 Increased back pressure to kidney and liver
22 total time vs Q total time vs HR total time vs CVP total time vs W Q/CVP/Ppao Q=7.1 Q= Time (hours) HR Total fluid removal 8810 L in 3 days
23 Decreased LV function by RV distention RV RV LV LV Can lead to decrease in LV function Decompress Overfill the the right right heart heart
24 Diastolic Ventricular Interaction in Chronic Heart Failure Atherton et al Lancet 1997 Overfilling of the right heart can decrease cardiac function
25 Looks like downward slope to Starling Curve Q Plateau Excess volume decreases cardiac function Volume does not increase cardiac output Pra
26 O 2 Delivery DO 2 = Q x Hb x K x Saturation mlo 2 /min = l/min g/l mlo 2 /g %
27 Increase DO 2 by increase in volume Volume infusion can increase cardiac output if heart not on plateau of the function curve DO 2 = Q x Hb x K x Sat Important consideration in hemorrhagic shock
28 However, 1 l of saline will also dilute [Hb] assuming BV of 4 l (after the bleed) the addition of 1 l of normal saline could decrease [Hb] to 72 g/l DO 2 Q Hb K Sat 369 mlo 2 /min = 3.0 L/min 90 K (1.37) 100% 555 mlo 2 /min = 4.5 L/min 90 K (1.37) 100% 443 mlo 2 /min = 4.5 L/min 72 K (1.37) 100%
29 Amount of H 2 O affects ph 1 Litre 2 Litre Na + Cl meq/l 2 X Na + Cl meq/l SID = 40 meq/l SID = 20 meq/l ph ph 11.66
30 Saline Acidosis SID = 40 Serum Na meq/l Total Body Na + : 140 x 42 = 5880 meq Add 10L of 0.9% saline = /52 = meq/l Serum Cl meq/l Total Body Cl - : 100 x 42 = 4220 meq Add 10L of 0.9% saline = /52 = meq/l SID = 32
31 Occult volume effects +ve 1. Reserves Interstitial unstressed 2. Restore perfusion 3. Non-volume effects Albumin Starch Even saline 1. Filtration -ve 2. Distort the RV 3. Wound healing 4. Liver/renal failure 5. Dilution ScvO 2 Hb INR 6. SID
Goal-directed vs Flow-guidedresponsive
Goal-directed vs Flow-guidedresponsive therapy S Magder Department of Critical Care, McGill University Health Centre Flow-directed vs goal directed strategy for management of hemodynamics S Magder Curr
More informationEvolutionary origins of the right ventricle. S Magder Department of Critical Care, McGill University Health Centre
Evolutionary origins of the right ventricle S Magder Department of Critical Care, McGill University Health Centre Fully separated four chamber heart only evolved in birds and mammals What are the evolutionary
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 informationFrom PV loop to Starling curve. S Magder Division of Critical Care, McGill University Health Centre
From PV loop to Starling curve S Magder Division of Critical Care, McGill University Health Centre Otto Frank 1890 s Frank-Starling Relationship ( The Law of the Heart ) The greater the initial stretch
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 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 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 informationHYPOVOLEMIA AND HEMORRHAGE UPDATE ON VOLUME RESUSCITATION HEMORRHAGE AND HYPOVOLEMIA DISTRIBUTION OF BODY FLUIDS 11/7/2015
UPDATE ON VOLUME RESUSCITATION HYPOVOLEMIA AND HEMORRHAGE HUMAN CIRCULATORY SYSTEM OPERATES WITH A SMALL VOLUME AND A VERY EFFICIENT VOLUME RESPONSIVE PUMP. HOWEVER THIS PUMP FAILS QUICKLY WITH VOLUME
More informationHow to resuscitate the patient in early sepsis? A physiological approach. J.G. van der Hoeven, Nijmegen
How to resuscitate the patient in early sepsis? A physiological approach J.G. van der Hoeven, Nijmegen Disclosure interests speaker (potential) conflict of interest Potentially relevant relationships with
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 informationHemodynamic Monitoring Pressure or Volumes? Antonio Pesenti University of Milan Italy
Hemodynamic Monitoring Pressure or Volumes? Antonio Pesenti University of Milan Italy antonio.pesenti@unimi.it CCCF 2017 Is it useful? YES: CVP It is an important diagnostic element! Your best guess CVP
More informationFluids in Sepsis: How much and what type? John Fowler, MD, FACEP Kent Hospital, İzmir Eisenhower Medical Center, USA American Hospital Dubai, UAE
Fluids in Sepsis: How much and what type? John Fowler, MD, FACEP Kent Hospital, İzmir Eisenhower Medical Center, USA American Hospital Dubai, UAE In critically ill patients: too little fluid Low preload,
More informationSHOCK. Emergency pediatric PICU division Pediatric Department Medical Faculty, University of Sumatera Utara H. Adam Malik Hospital
SHOCK Emergency pediatric PICU division Pediatric Department Medical Faculty, University of Sumatera Utara H. Adam Malik Hospital 1 Definition Shock is an acute, complex state of circulatory dysfunction
More informationTOPIC : Cardiogenic Shock
University of Ferrara Department of Morphology, Surgery and Experimental Medicine. Section of Anaesthesia and Intensive Care Medicine TOPIC : Cardiogenic Shock What is shock? Shock is a condition of inadequate
More informationHow and why I give IV fluid Disclosures SCA Fluids and public health 4/1/15. Andrew Shaw MB FRCA FCCM FFICM
How and why I give IV fluid Andrew Shaw MB FRCA FCCM FFICM Professor and Chief Cardiothoracic Anesthesiology Vanderbilt University Medical Center 2015 Disclosures Consultant for Grifols manufacturer of
More informationWhy would epidural analgesia cause these symptoms? How would increasing the blood volume change venous pressure (VP)?
CASE 12 A 25-year-old pregnant woman is in labor at the hospital. She has no medical problems and has had no complications with this pregnancy. She is in the active phase of labor, feeling intense contractions,
More informationReverse (fluid) resuscitation Should we be doing it? NAHLA IRTIZA ISMAIL
Reverse (fluid) resuscitation Should we be doing it? NAHLA IRTIZA ISMAIL 65 Male, 60 kg D1 in ICU Admitted from OT intubated Diagnosis : septic shock secondary to necrotising fasciitis of the R lower limb
More informationHaemodiafiltration - the case against. Prof Peter G Kerr Professor/Director of Nephrology Monash Health
Haemodiafiltration - the case against Prof Peter G Kerr Professor/Director of Nephrology Monash Health Know your opposition.. Haemodiafiltration NB: pre or post-dilution What is HDF how is it different
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. F Javier Belda Dept. Anesthesiology and Critical Care Hospital Clinico Universitario Valencia (Spain) Pulsion MAB
State of the Art Hemodynamic Monitoring III CO, preload, lung water and ScvO2 The winning combination! Dr. F Javier Belda Dept. Anesthesiology and Critical Care Hospital Clinico Universitario Valencia
More informationINTENSIVE CARE MEDICINE CPD EVENING. Dr Alastair Morgan Wednesday 13 th September 2017
INTENSIVE CARE MEDICINE CPD EVENING Dr Alastair Morgan Wednesday 13 th September 2017 WHAT IS NEW IN ICU? (RELEVANT TO ANAESTHETISTS) Not much! SURVIVING SEPSIS How many deaths in England were thought
More informationSepsis: Identification and Management in an Acute Care Setting
Sepsis: Identification and Management in an Acute Care Setting Dr. Barbara M. Mills DNP Director Rapid Response Team/ Code Resuscitation Stony Brook University Medical Center SEPSIS LECTURE NPA 2018 OBJECTIVES
More informationChapter 38: Pulmonary Circulation, Pulmonary Edema, Pleural Fluid UNIT VII. Slides by Robert L. Hester, PhD
UNIT VII Chapter 38: Pulmonary Circulation, Pulmonary Edema, Pleural Fluid Slides by Robert L. Hester, PhD Objectives Describe the pulmonary circulation Describe the pulmonary blood pressures List the
More informationFluid Resuscitation in Critically Ill Patients with Acute Kidney Injury (AKI)
Fluid Resuscitation in Critically Ill Patients with Acute Kidney Injury (AKI) Robert W. Schrier, MD University of Colorado School of Medicine Denver, Colorado USA Prevalence of acute renal failure in Intensive
More informationHypovolemic Shock: Regulation of Blood Pressure
CARDIOVASCULAR PHYSIOLOGY 81 Case 15 Hypovolemic Shock: Regulation of Blood Pressure Mavis Byrne is a 78-year-old widow who was brought to the emergency room one evening by her sister. Early in the day,
More informationICU treatment of the trauma patient. Intensive Care Training Program Radboud University Medical Centre Nijmegen
ICU treatment of the trauma patient Intensive Care Training Program Radboud University Medical Centre Nijmegen Christian Kleber Surgical Intensive Care Unit - The trauma surgery Perspective Langenbecks
More informationAcute Liver Failure: Supporting Other Organs
Acute Liver Failure: Supporting Other Organs Michael A. Gropper, MD, PhD Professor of Anesthesia and Physiology Director, Critical Care Medicine University of California San Francisco Acute Liver Failure
More informationMaternal and Fetal Physiology
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
More informationProf. Dr. Iman Riad Mohamed Abdel Aal
The Use of New Ultrasound Indices to Evaluate Volume Status and Fluid Responsiveness in Septic Shock Patients Thesis Submitted for partial fulfillment of MD degree in Anesthesiology, Surgical Intensive
More informationTechnique. Technique. Technique. Monitoring 1. Local anesthetic? Aseptic technique Hyper-extend (if radial)
Critical Care Monitoring Hemodynamic Monitoring Arterial Blood Pressure Cannulate artery Uses 2 Technique Sites Locate artery, prep 3 1 Technique Local anesthetic? Aseptic technique Hyper-extend (if radial)
More informationPresented by: Indah Dwi Pratiwi
Presented by: Indah Dwi Pratiwi Normal Fluid Requirements Resuscitation Fluids Goals of Resuscitation Maintain normal body temperature In most cases, elevate the feet and legs above the level of the heart
More informationCardiovascular Management of Septic Shock
Cardiovascular Management of Septic Shock R. Phillip Dellinger, MD Professor of Medicine Robert Wood Johnson Medical School/UMDNJ Director, Critical Care Medicine and Med/Surg ICU Cooper University Hospital
More informationThe Arterial and Venous Systems Roland Pittman, Ph.D.
The Arterial and Venous Systems Roland Pittman, Ph.D. OBJECTIVES: 1. State the primary characteristics of the arterial and venous systems. 2. Describe the elastic properties of arteries in terms of pressure,
More informationUPMC Critical Care
UPMC Critical Care www.ccm.pitt.edu Shock and Monitoring Samuel A. Tisherman, MD, FACS, FCCM Professor Departments of CCM and Surgery University of Pittsburgh Shock Anaerobic metabolism Lactic acidosis
More informationRelax and Learn At the Farm 2012
Relax and Learn At the Farm Session 9: Invasive Hemodynamic Assessment and What to Do with the Data Carol Jacobson RN, MN Cardiovascular Nursing Education Associates Function of CV system is to deliver
More informationManaging Patients with Sepsis
Managing Patients with Sepsis Diagnosis; Initial Resuscitation; ARRT Initiation Prof. Achim Jörres, M.D. Dept. of Nephrology and Medical Intensive Care Charité University Hospital Campus Virchow Klinikum
More informationUTILITY of ScvO 2 and LACTATE
UTILITY of ScvO 2 and LACTATE Professor Jeffrey Lipman Department of Intensive Care Medicine Royal Brisbane Hospital University of Queensland THIS TRIP SPONSORED AND PAID FOR BY STRUCTURE Physiology -
More informationFailure of the circulation to maintain Tissue cellular. Tissue hypoperfusion Cellular hypoxia SHOCK. Perfusion
Shock SHOCK Failure of the circulation to maintain Tissue cellular Perfusion Organs Syndrome RR
More informationWet Lungs Dry lungs Impact on Outcome in ARDS. Charlie Phillips MD Division of PCCM OHSU 2009
Wet Lungs Dry lungs Impact on Outcome in ARDS Charlie Phillips MD Division of PCCM OHSU 2009 Today s talk Pathophysiology of ARDS The case for dry Targeting EVLW Disclosures Advisor for Pulsion Medical
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 informationIN THE NAME OF GOD SHOCK MANAGMENT OMID MORADI MOGHADDAM,MD,FCCM IUMS ASSISTANT PROFESSOR
IN THE NAME OF GOD SHOCK MANAGMENT OMID MORADI MOGHADDAM,MD,FCCM IUMS ASSISTANT PROFESSOR The ability to evaluate and manage a critically ill patient is one of the most important skills any intensivist
More informationCath Lab Essentials: Basic Hemodynamics for the Cath Lab and ICU
Cath Lab Essentials: Basic Hemodynamics for the Cath Lab and ICU Ailin Barseghian El-Farra, MD, FACC Assistant Professor, Interventional Cardiology University of California, Irvine Department of Cardiology
More informationManagement of Cardiogenic Shock. Dr Stephen Pettit, Consultant Cardiologist
Dr Stephen Pettit, Consultant Cardiologist Cardiogenic shock Management of Cardiogenic Shock Outline Definition, INTERMACS classification Medical management of cardiogenic shock PA catheters and haemodynamic
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 informationCase discussion. 2011/03/05 Speaker: R1 游姿寧 Supervisor: F2 黃婷韵
Case discussion 2011/03/05 Speaker: R1 游姿寧 Supervisor: F2 黃婷韵 Discussion Shock Metabolic acidosis Definition of shock An imbalance between tissue oxygen supply (delivery) and oxygen demand (consumption)
More informationThe Hemodynamic Puzzle
The Hemodynamic Puzzle SVV NIRS O 2 ER Lactate Energy Metabolism (Oxygen Consumption) (Ml/min/m 2 ) Oxygen Debt: To Pay or Not to Pay? Full Recovery Possible Delayed Repayment of O 2 Debt Oxygen Deficit
More informationSepsis and septic shock Practical hemodynamic consequences. Intensive Care Training Program Radboud University Medical Centre Nijmegen
Sepsis and septic shock Practical hemodynamic consequences Intensive Care Training Program Radboud University Medical Centre Nijmegen Septic cardiomyopathy Present in > 50% and often masked by low vascular
More information12/29/2014. IV/IO Therapy & Fluid Administration. Objectives. Cleansing of the soul
IV/IO Therapy & Fluid Administration Gary Hoertz, EMT-P Spokane County EMS Indications for IV Access Types of Intravenous Access IV fluids Flow Rates Fluid resuscitation Objectives Cleansing of the soul
More informationHemodynamic monitoring beyond cardiac output
Hemodynamic monitoring beyond cardiac output Prof Xavier MONNET Medical Intensive Care Unit Bicêtre Hospital Assistance publique Hôpitaux de Paris FRANCE Conflicts of interest Lilly GlaxoSmithKline Pulsion
More informationIV fluid administration in sepsis. Dr David Inwald Consultant in PICU St Mary s Hospital, London CATS, London
IV fluid administration in sepsis Dr David Inwald Consultant in PICU St Mary s Hospital, London CATS, London The talk What is septic shock? What are the recommendations? What is the evidence? Do we follow
More informationCardiovascular system
Cardiovascular system L-4 Blood pressure & special circulation Dr Than Kyaw 27 February 2012 Blood Pressure (BP) Pressure generation and flow Blood is under pressure within its closed system. Pressure
More informationThe Use of Dynamic Parameters in Perioperative Fluid Management
The Use of Dynamic Parameters in Perioperative Fluid Management Gerard R. Manecke Jr., M.D. Chief, Cardiac Anesthesia UCSD Medical Center San Diego, CA, USA Thanks to Tom Higgins, M.D. 1 Goals of today
More informationBlood Flow, Blood Pressure, Cardiac Output. Blood Vessels
Blood Flow, Blood Pressure, Cardiac Output Blood Vessels Blood Vessels Made of smooth muscle, elastic and fibrous connective tissue Cells are not electrically coupled Blood Vessels Arteries arterioles
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 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 informationFluid bolus of 20% Albumin in post-cardiac surgical patient: a prospective observational study of effect duration
Fluid bolus of 20% Albumin in post-cardiac surgical patient: a prospective observational study of effect duration Investigators: Salvatore Cutuli, Eduardo Osawa, Rinaldo Bellomo Affiliations: 1. Department
More informationComment on infusion solutions containing HES
Comment on infusion solutions containing HES The European Medicines Agency (EMA) published on 14 June 2013 Pharmacovigilance Risk Assessment Committee (PRAC) recommends suspending marketing authorisations
More informationWE NEED TO REDISCOVER PHYSIOLOGY!
WE NEED TO REDISCOVER PHYSIOLOGY! MERVYN SINGER BLOOMSBURY INSTITUTE OF INTENSIVE CARE MEDICINE UNIVERSITY COLLEGE LONDON, UK DECLARATIONS OF INTEREST GE Healthcare (manufacturer of Venue ultrasound/echo)
More informationSepsis care and the new core measures
Sepsis care and the new core measures Daniel S. Hagg, MD January 15, 2016 Outline What is sepsis? A brief history of sepsis care How should we take care of septic patients now? Core measures What strategies
More informationIV Fluids. I.V. Fluid Osmolarity Composition 0.9% NaCL (Normal Saline Solution, NSS) Uses/Clinical Considerations
IV Fluids When administering IV fluids, the type and amount of fluid may influence patient outcomes. Make sure to understand the differences between fluid products and their effects. Crystalloids Crystalloid
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 informationStaging Sepsis for the Emergency Department: Physician
Staging Sepsis for the Emergency Department: Physician Sepsis Continuum 1 Sepsis Continuum SIRS = 2 or more clinical criteria, resulting in Systemic Inflammatory Response Syndrome Sepsis = SIRS + proven/suspected
More informationShock. William Schecter, MD
Shock William Schecter, MD The Cell as a furnace O 2 1 mole Glucose Cell C0 2 ATP 38 moles H 2 0 Shock = Inadequate Delivery of 02 and Glucose to the Cell 0 2 Cell ATP 2 moles Lactic Acid Treatment of
More informationDEMYSTIFYING VADs. Nicolle Choquette RN MN Athabasca University
DEMYSTIFYING VADs Nicolle Choquette RN MN Athabasca University Objectives odefine o Heart Failure o VAD o o o o Post Operative Complications Acute Long Term Nursing Interventions What is Heart Failure?
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 informationSepsis Care and the New Core Measures. Daniel S. Hagg, MD January 15, 2016
Sepsis Care and the New Core Measures Daniel S. Hagg, MD January 15, 2016 Outline What is sepsis? A brief history of sepsis care How should we take care of septic patients now? Core measures What strategies
More informationFluid Resuscitation and Monitoring in Sepsis. Deepa Gotur, MD, FCCP Anne Rain T. Brown, PharmD, BCPS
Fluid Resuscitation and Monitoring in Sepsis Deepa Gotur, MD, FCCP Anne Rain T. Brown, PharmD, BCPS Learning Objectives Compare and contrast fluid resuscitation strategies in septic shock Discuss available
More informationPERANAN LAKTAT PADA PASIEN KRITIS DI ICU. Prof. Dr. dr. Made Wiryana, SpAn.KIC.KAO
PERANAN LAKTAT PADA PASIEN KRITIS DI ICU Prof. Dr. dr. Made Wiryana, SpAn.KIC.KAO History of Lactate Karl Scheele, 1780 found in sour milk Joseph Scherer the German physician-chemist after 70 years demonstrate
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 informationFLUIDS AND SOLUTIONS IN THE CRITICALLY ILL. Daniel De Backer Department of Intensive Care Erasme University Hospital Brussels, Belgium
FLUIDS AND SOLUTIONS IN THE CRITICALLY ILL Daniel De Backer Department of Intensive Care Erasme University Hospital Brussels, Belgium Why do we want to administer fluids? To correct hypovolemia? To increase
More informationPHYSIOLOGY AND MANAGEMENT OF THE SEPTIC PATIENT
PHYSIOLOGY AND MANAGEMENT OF THE SEPTIC PATIENT Melanie Sanchez, RN, MSNE, OCN, CCRN Clinical Nurse III City of Hope National Medical Center HOW THE EXPERTS TREAT HEMATOLOGIC MALIGNANCIES LAS VEGAS, NV
More informationPhysiology Unit 3 CARDIOVASCULAR PHYSIOLOGY: THE VASCULAR SYSTEM
Physiology Unit 3 CARDIOVASCULAR PHYSIOLOGY: THE VASCULAR SYSTEM In Physiology Today Hemodynamics F = ΔP/R Blood flow (F) High to low pressure Rate = L/min Pressure (P) Hydrostatic pressure Pressure exerted
More informationManagement of Acute Shock and Right Ventricular Failure
Management of Acute Shock and Right Ventricular Failure Nader Moazami, MD Department of Thoracic and Cardiovascular Surgery and Biomedical Engineering, Cleveland Clinic NONE Disclosures CARDIOGENIC SHOCK
More informationWanchai Wongkornrat Cardiovascular Thoracic Surgery Siriraj Hospital Mahidol University
Wanchai Wongkornrat Cardiovascular Thoracic Surgery Siriraj Hospital Mahidol University Assess adequacy of ventilation and oxygenation Aids in establishing a diagnosis and severity of respiratory failure
More informationCARDIAC OUTPUT,VENOUS RETURN AND THEIR REGULATION. DR.HAROON RASHID. OBJECTIVES
CARDIAC OUTPUT,VENOUS RETURN AND THEIR REGULATION. DR.HAROON RASHID. OBJECTIVES Define Stroke volume, Cardiac output Venous return,& identity their normal values. Describe control (intrinsic & extrinsic)
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 informationBurn Resuscitation Formulas. John P. Sabra, MD Seton Surgical Group Department of Surgery Dell Medical School Austin, TX
Burn Resuscitation Formulas John P. Sabra, MD Seton Surgical Group Department of Surgery Dell Medical School Austin, TX BURN INJURY % Physiologic Change % TBSA burn Stasis BURN VASCULAR PERMEABILITY
More informationRevision of 10/27/2017 Form #280 Page 1 of 12 PVDOMICS STUDY Clinical Center Right Heart Catheterization (RHC) Results Form #280
Revision of 10/27/2017 Form #280 Page 1 of 12 PVDOMICS STUDY Clinical Center Right Heart Catheterization (RHC) Results Form #280 Instructions: Review PVDOMICS MOP Chapter 100 prior to completing right
More informationMASSIVE TRANSFUSION DR.K.HITESH KUMAR FINAL YEAR PG DEPT. OF TRANSFUSION MEDICINE
MASSIVE TRANSFUSION DR.K.HITESH KUMAR FINAL YEAR PG DEPT. OF TRANSFUSION MEDICINE CONTENTS Definition Indications Transfusion trigger Massive transfusion protocol Complications DEFINITION Massive transfusion:
More informationAcute Mechanical Circulatory Support Right Ventricular Support Devices
Acute Mechanical Circulatory Support Right Ventricular Support Devices Navin K. Kapur, MD, FACC, FSCAI, FAHA Associate Professor, Department of Medicine Interventional Cardiology & Advanced Heart Failure
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 informationStructure. Arteries. 21_01d 4/18/12. The Cardiovascular System: Blood Vessels and Hemodynamics. Dr Badri Paudel GMC
Goal of the Cardiovascular System: deliver blood to all parts of the body The Cardiovascular System: Blood Vessels and Hemodynamics Dr Badri Paudel GMC Does so by using different types of tubing, attached
More informationBrief View of Calculation and Measurement of Cardiac Hemodynamics
Cronicon OPEN ACCESS EC CARDIOLOGY Review Article Brief View of Calculation and Measurement of Cardiac Hemodynamics Samah Alasrawi* Pediatric Cardiologist, Al Jalila Children Heart Center, Dubai, UAE *
More informationR2R: Severe sepsis/septic shock. Surat Tongyoo Critical care medicine Siriraj Hospital
R2R: Severe sepsis/septic shock Surat Tongyoo Critical care medicine Siriraj Hospital Diagnostic criteria ACCP/SCCM consensus conference 1991 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference
More informationSwans and Pressors. Vanderbilt Surgery Summer School Ricky Shinall
Swans and Pressors Vanderbilt Surgery Summer School Ricky Shinall SHOCK Hypotension SHOCK Hypotension SHOCK=Reduction of systemic tissue perfusion, resulting in decreased oxygen delivery to the tissues.
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 informationSwans and Pressors. Vanderbilt Surgery Summer School Ricky Shinall
Swans and Pressors Vanderbilt Surgery Summer School Ricky Shinall Shock, Swans, Pressors in 15 minutes 4 Reasons for Shock 4 Swan numbers to know 7 Pressors =15 things to know 4 Reasons for Shock Not enough
More informationSepsis Update: Focus on Early Recognition and Intervention. Disclosures
Sepsis Update: Focus on Early Recognition and Intervention Jessie Roske, MD October 2017 Disclosures I have no actual or potential conflict of interest in relation to this program/presentation. I will
More informationStandard Operating Procedure (SOP) Management of intervention group patients SOP 001
` Standard Operating Procedure (SOP) Management of intervention group patients SOP 001 Authors: Mark Edwards & Rupert Pearse Authorisation: Rupert Pearse (Chief Investigator) Scope To provide guidance
More informationVasoactive Medications. Matthew J. Korobey Pharm.D., BCCCP Critical Care Clinical Specialist Mercy St. Louis
Vasoactive Medications Matthew J. Korobey Pharm.D., BCCCP Critical Care Clinical Specialist Mercy St. Louis Objectives List components of physiology involved in blood pressure Review terminology related
More information7/4/2015. diffuse lung injury resulting in noncardiogenic pulmonary edema due to increase in capillary permeability
Leanna R. Miller, RN, MN, CCRN-CMC, PCCN-CSC, CEN, CNRN, CMSRN, NP Education Specialist LRM Consulting Nashville, TN Objectives Identify the 5 criteria for the diagnosis of ARDS. Discuss the common etiologies
More informationTransfusion Requirements and Management in Trauma RACHEL JACK
Transfusion Requirements and Management in Trauma RACHEL JACK Overview Haemostatic resuscitation Massive Transfusion Protocol Overview of NBA research guidelines Haemostatic resuscitation Permissive hypotension
More informationDESCRIBE THE FACTORS AFFECTING CARDIAC OUTPUT.
DESCRIBE THE FACTORS AFFECTING CARDIAC OUTPUT. BY: DISHA PRAKASH I MBBS, ROLL NO: 16M069 OBJECTIVES OF LEARNING Terminology and conceptual understanding of Cardiac Output. Factors regulating Cardiac Output.
More informationCARDIOGENIC SHOCK. Antonio Pesenti. Università degli Studi di Milano Bicocca Azienda Ospedaliera San Gerardo Monza (MI)
CARDIOGENIC SHOCK Antonio Pesenti Università degli Studi di Milano Bicocca Azienda Ospedaliera San Gerardo Monza (MI) Primary myocardial dysfunction resulting in the inability of the heart to mantain an
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 informationMANAGEMENT OF CIRCULATORY FAILURE
MANAGEMENT OF CIRCULATORY FAILURE BACKGROUND AND DEFINITION There is no consensus on the definition of circulatory failure or shock in newborns; it can be defined as global tissue hypoxia secondary to
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 informationBlood Vessels. Chapter 20
Blood Vessels Chapter 20 Summary of the Characteristics of Arteries and Veins Characteristic Artery Vein Wall thickness thick thin Shape in cross section round flattened Thickest tunic media externa Collagen
More information