Hemodynamics & Medical Emergencies
Shock
This life-threatening condition can result in damage to multiple organs.
The condition requires immediate medical treatment; it can worsen rapidly if it goes untreated,
resulting in death.
Shock takes three main forms: hypovolemic, cardiogenic, and vasogenic:
Hypovolemic shock is caused by internal or external blood or fluid loss.
Cardiogenic shock is associated with cardiac problems; in this type of shock the heart is unable
to pump sufficient blood for the body’€™s needs.
Vasogenic shock results from massive vasodilation; anaphylactic shock (associated with an
allergic reaction), septic shock (associated with infection), and neurogenic shock (associated with
injury to the neurological system) are all types of vasogenic shock.
In the event of shock, the nurse should do the following:
Elevate the legs
Notify the physician
Determine and treat the cause of shock
Administer oxygen, as prescribed
Monitor level of consciousness
Monitor vital signs for increased pulse or decreased blood pressure
Monitor intake and output
Assess color, temperature, turgor, and moisture of the skin and mucous membranes
Administer IV fluids, blood, and colloid solutions, as prescribed
, Hemodynamic Measurements
Both, invasive and non-invasive techniques can be used to measure a patient’s hemodynamic
status.
The purpose of invasive hemodynamic monitoring is to detect and monitor changes in
intravascular pressures and cardiac output. This allows for optimum patient management.
Preload: amount of blood returning to the heart and filling the ventricles at the end of diastole.
Increased preload increases the stroke volume, ventricular work, and myocardial O2 demand.
Afterload: pressure ventricles has to overcome to eject its contents into the aortic (Systemic
Vascular Resistance) and pulmonary (Pulmonary Vascular Resistance) valves during systole.
Increases afterload causes the heart to work harder and demand more O2. It eventually causes
to a decrease in ventricular compliance and stroke volume.
Intraarterial Blood Pressure Monitoring
Monitoring is indicated for any major condition that compromises cardiac output, tissue
perfusion, or fluid volume status.
An arterial pressure waveform is displayed on a bedside monitor that shows continuous
measurement of systolic, diastolic, and mean arterial blood pressures (BPs).
Mean arterial pressure (MAP) is an approximation of the average pressure in the systemic
circulation throughout the cardiac cycle; it must be at least 60 mm Hg for adequate organ
perfusion.
Direct arterial access for the measurement of pressures is helpful for clients who require
frequent blood sampling, particularly for arterial blood gases.
Central venous pressure (CVP) is the pressure within the superior vena cava; this reading reflects
the pressure under which blood is returned to the superior vena cava and right atrium.
CVP is measured with the use of a central venous line in the superior vena cava or a balloon
flotation catheter in the pulmonary artery.
Normal CVP pressure is 2 to 8 mm Hg.
An increased CVP indicates an increase in blood volume as a result of sodium and water
retention, excessive intravenous (IV) fluids, alterations in fluid balance, or renal failure.
Decreased CVP indicates a decrease in circulating blood volume and may be the result of fluid
imbalance, hemorrhage, or severe vasodilation with pooling of blood in the extremities that
limits venous return.
Pulmonary Artery Pressure
A pulmonary artery catheter is used to measure right atrial and indirect left atrial pressures or
pulmonary artery wedge pressure (PAWP), which is also known as pulmonary artery occlusive
pressure (PAOP).
PAWP normally ranges between 6 and 12 mm Hg.
Normal right atrial (RA) pressure ranges from 2 to 8 mm Hg.
Normal pulmonary artery pressure (PAP) ranges from 15 to 26 mmHg systolic/5 to 15 mmHg
diastolic.
Shock
This life-threatening condition can result in damage to multiple organs.
The condition requires immediate medical treatment; it can worsen rapidly if it goes untreated,
resulting in death.
Shock takes three main forms: hypovolemic, cardiogenic, and vasogenic:
Hypovolemic shock is caused by internal or external blood or fluid loss.
Cardiogenic shock is associated with cardiac problems; in this type of shock the heart is unable
to pump sufficient blood for the body’€™s needs.
Vasogenic shock results from massive vasodilation; anaphylactic shock (associated with an
allergic reaction), septic shock (associated with infection), and neurogenic shock (associated with
injury to the neurological system) are all types of vasogenic shock.
In the event of shock, the nurse should do the following:
Elevate the legs
Notify the physician
Determine and treat the cause of shock
Administer oxygen, as prescribed
Monitor level of consciousness
Monitor vital signs for increased pulse or decreased blood pressure
Monitor intake and output
Assess color, temperature, turgor, and moisture of the skin and mucous membranes
Administer IV fluids, blood, and colloid solutions, as prescribed
, Hemodynamic Measurements
Both, invasive and non-invasive techniques can be used to measure a patient’s hemodynamic
status.
The purpose of invasive hemodynamic monitoring is to detect and monitor changes in
intravascular pressures and cardiac output. This allows for optimum patient management.
Preload: amount of blood returning to the heart and filling the ventricles at the end of diastole.
Increased preload increases the stroke volume, ventricular work, and myocardial O2 demand.
Afterload: pressure ventricles has to overcome to eject its contents into the aortic (Systemic
Vascular Resistance) and pulmonary (Pulmonary Vascular Resistance) valves during systole.
Increases afterload causes the heart to work harder and demand more O2. It eventually causes
to a decrease in ventricular compliance and stroke volume.
Intraarterial Blood Pressure Monitoring
Monitoring is indicated for any major condition that compromises cardiac output, tissue
perfusion, or fluid volume status.
An arterial pressure waveform is displayed on a bedside monitor that shows continuous
measurement of systolic, diastolic, and mean arterial blood pressures (BPs).
Mean arterial pressure (MAP) is an approximation of the average pressure in the systemic
circulation throughout the cardiac cycle; it must be at least 60 mm Hg for adequate organ
perfusion.
Direct arterial access for the measurement of pressures is helpful for clients who require
frequent blood sampling, particularly for arterial blood gases.
Central venous pressure (CVP) is the pressure within the superior vena cava; this reading reflects
the pressure under which blood is returned to the superior vena cava and right atrium.
CVP is measured with the use of a central venous line in the superior vena cava or a balloon
flotation catheter in the pulmonary artery.
Normal CVP pressure is 2 to 8 mm Hg.
An increased CVP indicates an increase in blood volume as a result of sodium and water
retention, excessive intravenous (IV) fluids, alterations in fluid balance, or renal failure.
Decreased CVP indicates a decrease in circulating blood volume and may be the result of fluid
imbalance, hemorrhage, or severe vasodilation with pooling of blood in the extremities that
limits venous return.
Pulmonary Artery Pressure
A pulmonary artery catheter is used to measure right atrial and indirect left atrial pressures or
pulmonary artery wedge pressure (PAWP), which is also known as pulmonary artery occlusive
pressure (PAOP).
PAWP normally ranges between 6 and 12 mm Hg.
Normal right atrial (RA) pressure ranges from 2 to 8 mm Hg.
Normal pulmonary artery pressure (PAP) ranges from 15 to 26 mmHg systolic/5 to 15 mmHg
diastolic.
