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Hemodynamic case studies

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by

angela trigg

on 19 November 2012

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Transcript of Hemodynamic case studies

A 67-y.o woman is admitted to the ICU with a dx. Of hypotension of unknown origin. She is presently unresponsive but is breathing spontaneously on her own. Lungs are clear, U.O. is 15ml in 8 hours, and her skin is cool. A PA catheter is inserted to obtain more information and guide therapy. The following information is revealed: BP 86/54mmHg
P 118/min
RR 30breaths/min
C.O. 3.5L/min
C.I. 1.9L/min
PA 24/10mmHg
PAOP 4mmHg
RAP 2mm/Hg
SVR 1393 dynes.
PVR 195 dynes
SvO2 50% Case One A 70 y.o. man is admitted to the ICU with hypotension and an acute inferior wall MI. He also has a HX of COPD. He has SOB accompanied with wheezing and crackles ½ way up his posterior lobes. An S3 gallop is noted. His vital signs and PA catheter reveal the following:
BP 102/68mm Hg
P 112/min
CO 4.0 L/min
CI 2.1L/min
PA 38/23 mm Hg
PAOP 21mm Hg
RAP 13 mm Hg
SVR 1326 dynes
PVR 140 dynes.
SvO2 49% Case Three An 80 y.o. woman is in the ICU with DCHF exacerbation. Her PA catheter gives the following information:
BP 114/76mm Hg
P 106/min
CO 3.8 L/min
CI 2.3L/min
PAP 40/23mm Hg
PAOP 22mm Hg
RAP 12mm Hg
SVR 1674 dynes.
PVR 140 dynes.
SvO2 56% Case Four A 60 y.o. man is in the ICU s/p an open cholecystectomy 3 days ago. He is complaining of generalized malaise and v.s. are reported as follows:
BP-90/46, P-110, RR-27, T-38.1C
A PA catheter is inserted to obtain more information. CO 10.5 L/min
CI 6.0 L/min
PA 22/11 mm/Hg
PAOP 8mm/Hg
RAP 2 mm/Hg
SVR 475 dynes.
SvO2 84%
PVR 51 dynes. Case Two RA- 3

PAP- 45/20 (28)

MAP- 70

SVR- 930

C.O.- 5.7

Mixed Venous- 77%Sat.

HR- 90 What is the Pulse Pressure? What does this tell us about this patients Stroke Volume?

Which Values tell us about this patient's filling pressures/fluid status? Are these values adequate?

Which Values tell us about this patient's contractility? Are these values adequate?

Which values tell us about this patients vascular resistance?

What is causing this patient's hypotension? Which initial therapy is appropriate? What is the Pulse Pressure? What does this tell us about this patients Stroke Volume?

Which Values tell us about this patient's filling pressures/fluid status? Are these values adequate?

Which Values tell us about this patient's contractility? Are these values adequate?

Which values tell us about this patients vascular resistance?

What is causing this patient's hypotension? Which initial therapy is appropriate? What is the Pulse Pressure? What does this tell us about this patients Stroke Volume?

Which Values tell us about this patient's filling pressures/fluid status? Are these values adequate?

Which Values tell us about this patient's contractility? Are these values adequate?

Which values tell us about this patients vascular resistance?

What is causing this patient's hypotension? Which initial therapy is appropriate? What is the Pulse Pressure? What does this tell us about this patients Stroke Volume?

Which Values tell us about this patient's filling pressures/fluid status? Are these values adequate?

Which Values tell us about this patient's contractility? Are these values adequate?

Which values tell us about this patients vascular resistance?

What is causing this patient's hypotension? Which initial therapy is appropriate? Case One Case Two Case Three Case Four RA RV LA LV
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