ABP - CVP

HEMODYNAMIC
MONITORING
LEARNSHOP - LEARNBOOK

FASCILITATOR - MANFRED MORTELL



JUNE 2012


2
CONTENTS


PRE-KNOWLEDGE QUESTIONS


3

INTRODUCTION AND OBJECTIVES


9

INDICATIONS


10

INSERTION SITES


10

REQUIREMENTS


11

PATIENT TRANSDUCER PLACEMENT


12

PRESSURE WAVEFORMS


13

NURSING CONSIDERATIONS


22

CASE REVIEW


23
POST LEARNSHOP QUESTIONS 28
REFERENCES 34




3
PRE KNOWLEDGE REVIEW- CIRCLE ONLY ONE (1) ANSWER





Q.1: CARDIAC OUTPUT IS THE PRODUCT OF
A) HEART RATE
B) STROKE VOLUME
C) PRELOAD
D) ALL THE ABOVE

Q.2 THE CARDIAC CYCLE CONSISTS OF
A) SYSTOLE
B) DIASTOLE
C) ISOVOLUMETRIC CONTRACTION & RELAXATION
D) ALL THE ABOVE

Q.3 A DICROTIC NOTCH ON AN ARTERIAL PRESSURE WAVEFORM
A) MEANS THE AORTIC VALVE IS OPEN
B) MEANS THE MITRAL VALVE IS CLOSED
C) MEANS THE AORTIC VALVE IS CLOSED
D) MEANS THE MITRAL VALVE IS OPEN

Q.4 STROKE VOLUME
A) IS THE AMOUNT OF BLOOD EJECTED WITH EACH HEART BEAT
B) IS THE PRODUCT OF CARDIAC OUTPUT CO / HEART RATE
C) IS CREATED BY HEART RATE PRELOAD AFTERLOAD
D) ALL THE ABOVE

Q.5 THE SYMPATHETIC NERVOUS SYSTEM
A) DECREASES HEART RATE
B) DECREASES CONTRACTILITY OF THE MYOCARDIUM
C) INCREASES CONTRACTILITY OF THE MYOCARDIUM
D) NON OF THE ABOVE
4
Q.6 A CENTRAL VENOUS CATHETER
A) CAN BE INSERTED INTO THE JUGULAR ARTERY
B) CAN BE INSERTED INTO THE JUGULAR VEIN
C) CAN BE INSERTED INTO THE JUGULAR CAPILLERY
D) ALL THE ABOVE

Q.7 COMPLICATIONS ARTERIAL CATHETER S (A - LINE) MAYBE
A) LIMB ISCHEMIA
B) DECREASED TISSUE PERFUSION
C) AIR EMBOLISM
D) ALL THE ABOVE

Q.8 A NORMAL BLOOD PRESSURE HAS A
A) SYSTOLIC COMPONENT
B) MEAN COMPONENT
C) DIASTOLIC COMPONENT
D) ALL THE ABOVE

Q.9 THE CVP
A) IS A CENTRAL VENOUS BLOOD PRESSURE
B) IS NORMALLY 0 8 mmHg
C) PROVIDES DATA ABOUT BLOOD VOLUME
D) ALL THE ABOVE

Q.10 POLY URIA AND DEHYDRATION MAY
A) CAUSE A LOW CVP
B) CAUSE A HIGH CVP
C) NOT EFFECT THE CVP
D) NONE OF THE ABOVE

Q.11 AN ALLENS TEST ASSESSES
A) FEMORAL ARTERY PATENCY
B) POPLITEAL ARTERY PATENCY
C) ULNAR ARTERY PATENCY
D) RADIAL ARTERY PATENCY
5


12: COMPLICATIONS OF A CENTRAL VENOUS CATHETER INCLUDE
A) INFECTION
B) AIR EMBOLISM
C) CARDIAC DYSRHYTHMIAS
D) ALL THE ABOVE


Q.13 COMPONENTS OF THE FLUSH SYSTEMINCLUDE
A) A PRESSURE BAG
B) NORMAL SALINE
C) A FLUSH VALVE IN THE TRANSDUCER
D) ALL THE ABOVE

Q.14 WHICH OF THE FOLLOWING ARE VITAL SIGNS
A) TEMPERATURE PULSE RESPIRATIONS BLOOD PRESSURE
B) PULSE OXIMETRY
C) PAIN ASSESSMENT
D) ALL OF THE ABOVE


Q.15 SIGNS OF DECREASED TISSUE PERFUSION CAUSED BY AN
ARTERIAL LINE COULD INCLUDE
A) COLD SKIN
B) PALE SKIN
C) PAIN
D) ALL THE ABOVE

Q.16 WHICH OF THE FOLLOWING ARE TYPES OF SHOCK
A) EXTREMELY BAD OR DISTRESSING NEWS
B) HYPOVOLEMIC
C) BRADYCARDIC
D) A SUDDEN FRIGHT

6
Q.17 COMPENSATED SHOCK MEANS
A) BP IS NORMAL AND SIGNS OF DECREASED TISSUE PERFUSION
B) THE BODY IS TRYING TO CORRECT THE PROBLEM
C) SNS COMPENSATORY MECHANISMS ARE ACTIVATED
D) ALL OF THE ABOVE

Q.18 THE MOST COMMON TYPE OF SHOCK IS
A) SEPTIC
B) ANAPHYLACTIC
C) HYPOVOLEMIC
D) NEUROGENIC

Q.19 THE TRANSDUCER MUST ALWAYS
A) BE ALIGNED TO THE PHLEBOSTATIC AXIS
B) BE ZEROED EVERY DAY OR PRN
C) BE PRIMED TO REMOVE AIR
D) ALL THE ABOVE

Q.20 THE SYSTEMIC ARTERIAL WAVEFORMDICROTIC NOTCH
A) MEANS THE PULMONIC VALVE HAS OPENED
B) MEANS THE PULMONIC VALVE HAS CLOSED
C) MEANS THE AORTIC VALVE HAS CLOSED
D) MEANS THE AORTIC VALVE HAS OPENED

Q.21 CVP IS THE SAME AS THE
A) ARTERIAL BLOOD PRESSURE
B) LEFT ATRIAL PRESSURE
C) JUGULAR VENOUS PULSE
D) RIGHT ATRIAL PRESSURE

Q.22 OVERDAMPING MEANS
A) THE TRANSDUCER MAYBE FAULTY
B) THE PRESSURE WAVE WILL BE SMALLER
C) INCORRECT DATA MAYBE PROVIDED
D) ALL THE ABOVE
7
Q.23 CARDIAC TAMPONADE MAYBE RECOGNISED BY
A) A LOW CVP
B) AN ELEVATED CVP
C) AN ALTERNATING HIGH AND LOW CVP
D) ALL THE ABOVE

Q.24 A PULMONARY EMBOLISMCAN CAUSE A CVP
A) TO ELEVATE ABOVE NORMAL
B) TO DECLINE BELOW NORMAL
C) TO REMAIN NORMAL
D) NONE OF THE ABOVE

Q.25: A CVP ASSESSES AND MEASURES
A) BLOOD VOLUME
B) CENTRAL VENOUS PRESSURE
C) RIGHT HEART FUNCTION
D) ALL THE ABOVE

Q.26: WHICH OF THE FOLLOWING ARE BLOOD VESSELS
A) CAPILLERIES
B) LYMPH NODES
C) THE RIGHT ATRIUM
D) ALL OF THE ABOVE

Q.27: AN ARTERIAL CATHETER CAN BE INSERTED INTO A
A) RADIAL ARTERY
B) FEMORAL ARTERY
C) DORSALIS PEDIS ARTERY
D) ALL OF THE ABOVE

Q.28: THE HEART RATE AT REST IS NORMALLY
A) 60 100 BPM IN THE ADULT OR CHILD
B) 80 120 BPM IN AN INFANT
C) 100 150 BPM IN A NEONATE
D) ALL THE ABOVE
8
Q.29: WHICH OF THE FOLLOWING SYSTOLIC ABP IS NORMAL
A) > 100 mmHg NEONATE
B) > 200 mmHg INFANT
C) > 90 mmHg ADULT
D) NONE OF THE ABOVE

Q.30: A LOWCVP MAY CAUSED BY
A) HYPOVOLEMIA
B) HYPERVOLEMIA
C) RIGHT HEART FAILURE
D) LEFT HEART FAILURE



















SELF ASSESSMENT SCORE: ________/ 30





9
ANSWERS






1 D

16 B
2 D

17 D
3 C

18 C
4 D

19 D
5 C

20 C
6 B

21 D
7 D

22 D
8 D

23 B
9 B

24 A
10 A

25 D
11 C

26 D
12 D

27 D
13 D

28 D
14 D

29 C
15 D

30 A


10
INTRODUCTION

THE PURPOSE THE PURPOSE
OF THIS OF THIS FACEBOOK LEARNSHOP FACEBOOK LEARNSHOP IS TO IS TO
ASSIST INTERESTED ASSIST INTERESTED
PARTICIPANTS PARTICIPANTS
TO IMPROVE CLINICAL TO IMPROVE CLINICAL
COMPREHENSION & THEORETICAL COMPREHENSION & THEORETICAL
KNOWLEDGE PERTAINING TO KNOWLEDGE PERTAINING TO
INVASIVE ARTERIAL & INVASIVE ARTERIAL & CENTRAL VENOUS CENTRAL VENOUS
HEMODYNAMIC MONITORING HEMODYNAMIC MONITORING
IN ADDITION, I WOULD LIKE TO ACKNOWLEDGE THAT SOME IMAGES IN ADDITION, I WOULD LIKE TO ACKNOWLEDGE THAT SOME IMAGES
WERE OBTAINED ON THE INTERNET AND IF COPYRIGHT HAS BEEN BREACHED WERE OBTAINED ON THE INTERNET AND IF COPYRIGHT HAS BEEN BREACHED IT WAS IT WAS
NOT SO INTENDED. THE PURPOSE IS TO PROVIDE KNOWLEDGE NOT SO INTENDED. THE PURPOSE IS TO PROVIDE KNOWLEDGE


OBJECTIVES

REVIEW& DISCUSS
REVIEW& DISCUSS
INDICATIONS FOR INDICATIONS FOR
COMPONENTS COMPONENTS
NORMAL WAVEFORMS NORMAL WAVEFORMS
ANOMALOUS WAVEFORMS ANOMALOUS WAVEFORMS
NURSING CONSIDERATIONS NURSING CONSIDERATIONS
CASE REVIEW CASE REVIEW

11
INDICATIONS

VOLUME ASSESSMENT
VOLUME ASSESSMENT
FLUID MANAGEMENT
FLUID MANAGEMENT
MEDICATION RESPONSE
MEDICATION RESPONSE
ASSESS RV FUNCTION
ASSESS RV FUNCTION
ASSESS SYSTEMIC BP
ASSESS SYSTEMIC BP



INSERTION SITES
JUGULAR VEIN
SUBCLAVIAN VEIN
ANTECUBITAL VEIN
BASILIC VEIN
CEPHALIC VEIN
FEMORAL VEIN



12
INSERTION SITES
RADIAL RADIAL
ARTERY ARTERY
DORSALIS DORSALIS
PEDIS ARTERY PEDIS ARTERY
FEMORAL FEMORAL
ARTERY ARTERY
BRACHIAL BRACHIAL
ARTERY ARTERY



REQUIREMENTS
PRESSURE BAG FLUSH SYSTEM PRESSURE BAG FLUSH SYSTEM
NORMAL SALINE FLUSH FLUID NORMAL SALINE FLUSH FLUID
TRANSDUCER TRANSDUCER
CATHETER CATHETER




13
PATIENT POSITION
SUPINE SUPINE
TRANSDUCER LEVEL WITHTHE PLEBOSTATIC AXIS
4
TH
INTERCOSTAL SPACE RIGHT MID AXILLARY LINE



RIGHT LATERAL RIGHT LATERAL
TRANSDUCER LEVEL WITHTHE PLEBOSTATIC AXIS
4
TH
INTERCOSTAL SPACE MID STERNAL LINE



TRANSDUCER LEVEL WITHTHE PLEBOSTATIC AXIS
4
TH
INTERCOSTAL SPACE LEFT STERNAL BORDER
LEFT LATERAL LEFT LATERAL



14
PRESSURE WAVEFORMS



ARTERIAL WAVEFORM



15
ANOMALOUS ARTERIAL WAVEFORMS

UNDER DAMPING





OVERDAMPING




SQUARE WAVE TEST
CONFIRMS CONFIRMS
OPTIMAL DAMPING OPTIMAL DAMPING - - CORRECT CORRECT
OVER DAMPING OVER DAMPING - - TOO MUCH TOO MUCH
UNDER DAMPING UNDER DAMPING - - NOT ENOUGH NOT ENOUGH





16
CLINICAL VARIATIONS

HYPOTENSION





HYPERTENSION



PVCS AFFECT STROKE VOLUME



17
CVP WAVEFORM















18
ANOMALOUS CVP WAVEFORMS

UNDERDAMPING





WANDERING BASELINE




INTERFERENCE - RESPIRATIONS




19
FLING



OBSTRUCTION

CLOTTED CLOTTED




CATHETER MIGRATION FORWARD





20
CLINICAL VARIATIONS

BRADYCARDIA




COMPLETE HEART BLOCK






ATRIAL FIBRILLATION


21
TRICUSPID STENOSIS



TRICUSPID REGURGITATION


CARDIAC TAMPONADE



22
NURSING CONSIDERATIONS - ARTERIAL


















NURSING CONSIDERATIONS - CVC


















23
CASE REVIEW
CASE 1
CASE 1

HISTORY & ASSESSMENT HISTORY & ASSESSMENT
COMPLAINT COMPLAINT - -ACHE (L) ARMNECK & JAW ACHE (L) ARMNECK & JAW
CNS CNS - - COLLAPSED COLLAPSED- -GCS 8/15 GCS 8/15
SKIN SKIN - - COLD PALE CLAMMY COLD PALE CLAMMY
CAPILLARY REFILL TIME CAPILLARY REFILL TIME- - 7 SECONDS 7 SECONDS
HEART RATE HEART RATE - - 125 BPM 125 BPM
BP BP - - 80/60 (70) mmHg 80/60 (70) mmHg
PULSE PULSE - - 110 PPM 110 PPM
CVP CVP - - 15 mmHg 15 mmHg
SpO2 SpO2 - - 85% 85%
PAIN PAIN - - 10/10 10/10 - - BEFORE COLLAPSE BEFORE COLLAPSE
RESPIRATIONS RESPIRATIONS - -32 BPM 32 BPM
LUNG SOUNDS LUNG SOUNDS - - COARSE CRACKLES COARSE CRACKLES





24
ECG
ST ELEVATION >3mm



COMPLAINT COMPLAINT - -UNSTABLE ANGINA UNSTABLE ANGINA
CNS CNS - -SEMICONSCIOUS SEMICONSCIOUS
SKIN SKIN - - VASOCONSTRICTED VASOCONSTRICTED
CAPILLARY REFILL TIME CAPILLARY REFILL TIME - -PROLONGED PROLONGED
HEART RATE HEART RATE - -TACHYCARDIA TACHYCARDIA
ECG ECG - -ST ELEVATION MI ST ELEVATION MI
BP BP - -HYPOTENSIVE HYPOTENSIVE
CVP CVP - -ELEVATED ELEVATED
RESPIRATIONS RESPIRATIONS - -TACHYPNEA TACHYPNEA
LUNG SOUNDS LUNG SOUNDS - -HEART FAILURE HEART FAILURE
PROBLEM PROBLEM- -CARDIOGENIC SHOCK DUE TO ACUTE MI CARDIOGENIC SHOCK DUE TO ACUTE MI
EVALUATION FINDINGS
EVALUATION FINDINGS


25
CASE 2
CASE 2


HISTORY & ASSESSMENT HISTORY & ASSESSMENT
COMPLAINT COMPLAINT- - SOB SOBDYSPNEA LEFT SIDED CHEST PAIN DYSPNEA LEFT SIDED CHEST PAIN
CNS CNS - -TERRIFIED TERRIFIED - -ALERT ALERT - -ORIENTATED ORIENTATED
SKIN SKIN - - COOL CYANOSED COOL CYANOSED
CAPILLARY REFILL TIME CAPILLARY REFILL TIME - - 5 SECONDS 5 SECONDS
ECG ECG - - SINUS TACHYCARDIA & NON SUSTAINED VT SINUS TACHYCARDIA & NON SUSTAINED VT
HEART RATE HEART RATE - - 120 BPM 120 BPM
PULSE PULSE - - 110 110 - -WEAK RAPID WEAK RAPID - - GRADE 1 GRADE 1
CVP CVP - - 24 mmHg 24 mmHg
CHEST PAIN CHEST PAIN - - SHARP 10/10 SHARP 10/10
HEART SOUNDS HEART SOUNDS - - S3 S3
RESPIRATIONS RESPIRATIONS - -32 BPM 32 BPM- -HEMOPTYSIS HEMOPTYSIS
SpO2 SpO2 - - 79% 79%
LUNG SOUNDS LUNG SOUNDS - - DECREASED AIR ENTRY LEFT CHEST DECREASED AIR ENTRY LEFT CHEST







26
ECG
TACHYCARDIA
TACHYCARDIA
VENTRICULAR RHYTHMS
VENTRICULAR RHYTHMS


COMPLAINT COMPLAINT - -PLEURITC CHEST PAIN PLEURITC CHEST PAIN
CNS CNS - -GCS 15/15 GCS 15/15
SKIN SKIN - - VASOCONSTRICTED VASOCONSTRICTED
CAPILLARY REFILL TIME CAPILLARY REFILL TIME - -PROLONGED PROLONGED
HEART RATE HEART RATE - -TACHYCARDIA & PULSE DEFICIT 10 BPM TACHYCARDIA & PULSE DEFICIT 10 BPM
ECG ECG - -SINUS TACHYCARDIA & NON SUSTAINED VT SINUS TACHYCARDIA & NON SUSTAINED VT
BP BP - -HYPOTENSIVE HYPOTENSIVE
CVP CVP - -ELEVATED ELEVATED
CHEST PAIN CHEST PAIN - - PLEURITIC PLEURITIC
RESPIRATIONS RESPIRATIONS - -TACHYPNEA TACHYPNEA
LUNG SOUNDS LUNG SOUNDS - - DECREASED DUE TO PROBABLE HEMORRHAGE DECREASED DUE TO PROBABLE HEMORRHAGE
SpO2 SpO2 - -HYPOXIA HYPOXIA
PROBLEM PROBLEM- -SHOCK DUE TO PROBABLE PULMONARY EMBOLISM SHOCK DUE TO PROBABLE PULMONARY EMBOLISM
EVALUATION FINDINGS EVALUATION FINDINGS

27
CASE 3
CASE 3


HISTORY & ASSESSMENT HISTORY & ASSESSMENT
CNS CNS - - VERY ANXIOUS VERY ANXIOUS - - ALERT ALERT - - ORIENTATED ORIENTATED - - FATIGUED FATIGUED - - WEAK WEAK
SKIN SKIN - - COOL CLAMMY COOL CLAMMY
PULSE PULSE - - 125 BPM 125 BPM- - WEAK WEAK - - GRADE 1 GRADE 1
ECG ECG - - SINUS TACHYCARDIA SINUS TACHYCARDIA
HEART RATE HEART RATE - - 145 BPM 145 BPM
BLOOD PRESSURE BLOOD PRESSURE- - 70/50 mmHg 70/50 mmHg
PULSE PRESSURE PULSE PRESSURE - - 20 mmHg 20 mmHg
CVP CVP - - 24 mmHg & 24 mmHg &KUSSMALS SIGN KUSSMALS SIGN
HEART SOUNDS HEART SOUNDS - - MUFFLED MUFFLED
RESPIRATIONS RESPIRATIONS - - 36 BPM 36 BPM
SpO2 SpO2 - - 75% 75%
LUNG SOUNDS LUNG SOUNDS - - CLEAR CLEAR
URINE OUTPUT URINE OUTPUT - - NIL NIL




28
CXR
CXR
CLEAR LUNG FIELDS CLEAR LUNG FIELDS
BIG HEART BIG HEART
SEE FACEBOOK CXR LEARNSHOP SEE FACEBOOK CXR LEARNSHOP PART 5 PART 5




ECHO
ECHO
PERICARDIAL FLUID
PERICARDIAL FLUID




29
COMPLAINT COMPLAINT - - UNSTABLE ANGINA UNSTABLE ANGINA
CNS CNS - - ALERT ALERT- - GCS 15/15 GCS 15/15
SKIN SKIN - - VASOCONSTRICTED VASOCONSTRICTED
CAPILLARY REFILL TIME CAPILLARY REFILL TIME - - PROLONGED PROLONGED
HEART RATE HEART RATE - - TACHYCARDIA TACHYCARDIA
HEART SOUNDS HEART SOUNDS - - MUFFLED DUE TO COMPRESSION/TAMPONADE MUFFLED DUE TO COMPRESSION/TAMPONADE
ECG ECG - - TACHYCARDIA TACHYCARDIA
BP BP - - SEVERE SEVEREHYPOTENSION HYPOTENSION
PULSE PRESSURE PULSE PRESSURE- - NARROW NARROW
CVP CVP - - ELEVATED ELEVATED - - KUSSMALS SIGN KUSSMALS SIGNOF PULSUS PARADOXUS OF PULSUS PARADOXUS
RESPIRATIONS RESPIRATIONS - - TACHYPNEA TACHYPNEA
SpO2 SpO2 - - HYPOXIA HYPOXIA
LUNG SOUNDS LUNG SOUNDS - - CLEAR CLEAR
PROBLEM PROBLEM- - CARDIOGENIC SHOCK DUE TO CARDIAC TAMPONADE CARDIOGENIC SHOCK DUE TO CARDIAC TAMPONADE
EVALUATION FINDINGS
EVALUATION FINDINGS

















30
POST KNOWLEDGE REVIEW- CIRCLE ONLY ONE (1) ANSWER




Q.1: CARDIAC OUTPUT IS THE PRODUCT OF
A) HEART RATE
B) STROKE VOLUME
C) PRELOAD
D) ALL THE ABOVE

Q.2 THE CARDIAC CYCLE CONSISTS OF
A) SYSTOLE
B) DIASTOLE
C) ISOVOLUMETRIC CONTRACTION & RELAXATION
D) ALL THE ABOVE

Q.3 A DICROTIC NOTCH ON AN ARTERIAL PRESSURE WAVEFORM
A) MEANS THE AORTIC VALVE IS OPEN
B) MEANS THE MITRAL VALVE IS CLOSED
C) MEANS THE TRICUSPID VALVE IS CLOSED
D) NONE OF THE ABOVE

Q.4 STROKE VOLUME
A) IS THE AMOUNT OF BLOOD EJECTED WITH EACH HEART BEAT
B) IS THE PRODUCT OF CARDIAC OUTPUT CO / HEART RATE
C) IS CREATED BY HEART RATE PRELOAD AFTERLOAD
D) ALL THE ABOVE

Q.5 THE SYMPATHETIC NERVOUS SYSTEM
A) DECREASES HEART RATE
B) DECREASES CONTRACTILITY OF THE MYOCARDIUM
C) INCREASES CONTRACTILITY OF THE MYOCARDIUM
D) NONE OF THE ABOVE

31
Q.6 A CENTRAL VENOUS CATHETER
A) CAN BE INSERTED INTO THE JUGULAR VEIN
B) CAN BE INSERTED INTO THE FEMORAL VEIN
C) CAN BE INSERTED INTO THE SUBCLAVIAN VEIN
D) ALL THE ABOVE

Q.7 COMPLICATIONS ARTERIAL CATHETER S (A - LINE) MAYBE
A) LIMB ISCHEMIA
B) DECREASED TISSUE PERFUSION
C) AIR EMBOLISM
D) ALL THE ABOVE

Q.8 A NORMAL ARTERIAL PRESSURE WAVEFORMHAS A/AN
A) ANACROTIC COMPONENT
B) DICROTIC COMPONENT
C) DICROTIC NOTCH
D) ALL THE ABOVE

Q.9 THE CVP
A) IS THE SAME AS THE RIGHT ATRIAL PRESSURE
B) IS NORMALLY 0 8 mmHg
C) PROVIDES DATA ABOUT THE RIGHT SIDE OF THE HEART
D) ALL THE ABOVE

Q.10 SEVERE HEMORRHAGE MAY
A) CAUSE A LOW CVP
B) CAUSE A HIGH CVP
C) NOT EFFECT THE CVP
D) NONE OF THE ABOVE

Q.11 AN ALLENS TEST ASSESSES
A) FEMORAL ARTERY PATENCY
B) POPLITEAL ARTERY PATENCY
C) ULNAR ARTERY PATENCY
D) NONE OF THE ABOVE
32


12: INSERTION OF A CENTRAL VENOUS CATHETER MAY CAUSE A
A) PNEUMOTHORAX
B) AIR EMBOLISM
C) CARDIAC DYSRHYTHMIAS
D) ALL THE ABOVE


Q.13 A PRESSURE BAG IN THE FLUSH SYSTEMMUST
A) BE PRESSURIZED TO 300 mmHg
B) HAVE A BAG OF NORMAL SALINE FLUID VOLUME
C) BE CONNECTED TO THE FLUSH VALVE IN THE TRANSDUCER
D) ALL THE ABOVE

Q.14 WHICH PRESSURE IS SIMILAR TO THE JUGULAR VENOUS
PULSE
A) ABP
B) CVP
C) PAP
D) PCWP

Q.15 AN A LINE COULD CAUSE WHICH OF THE FOLLOWING
A) LIMB ISCHEMIA
B) TISSUE NECROSIS
C) PAIN
D) ALL THE ABOVE

Q.16 HYPOVOLEMIA WOULD BE BEST DIAGNOSED BY
A) ARTERIAL BLOOD PRESSURE
B) CENTRAL VENOUS PRESSURE
C) CAPILLARY REFILL TIME
D) ASSESSING SKIN TURGOR

33
Q.17 COMPENSATED SHOCK MEANS
A) BP IS NORMAL AND SIGNS OF DECREASED TISSUE PERFUSION
B) THE BODY IS TRYING TO CORRECT THE PROBLEM
C) SNS COMPENSATORY MECHANISMS ARE ACTIVATED
D) ALL OF THE ABOVE

Q.18 SHOCK IS BEST DIAGNOSED BY
A) HISTORY
B) PHYSICAL ASSESSMENT
C) ARTERIAL BLOOD PRESSURE
D) ALL THE ABOVE

Q.19 THE TRANSDUCER MUST ALWAYS
A) BE ALIGNED TO THE PHLEBOSTATIC AXIS
B) THE 4
TH
INTERCOSTAL SPACE MID AXILLARY LINE
C) ZEROED TO ATMOSPHERE
D) ALL THE ABOVE

Q.20 THE SYSTEMIC ARTERIAL WAVEFORMDICROTIC NOTCH
A) MEANS THE PULMONIC VALVE HAS OPENED
B) MEANS THE PULMONIC VALVE HAS CLOSED
C) MEANS THE AORTIC VALVE HAS CLOSED
D) MEANS THE AORTIC VALVE HAS OPENED

Q.21 THE CVP IS ELEVATED IF
A) THE PATIENT IS HYPOVOLEMIC
B) THE PATIENT HAS A PULMONARY EMBOLISM
C) THE PATIENT IS LYING SUPINE
D) THE WAVEFORM IS OVER DAMPED

Q.22 OVERDAMPING MEANS
A) THE TRANSDUCER IS FUNCTIONING NORMALLY
B) THE PRESSURE WAVE WILL BE BIGGER THAN NORMAL
C) CORRECT DATA WILL BE PROVIDED
D) NONE OF THE ABOVE
34
Q.23 CARDIAC TAMPONADE MAYBE RECOGNISED BY
A) SEVERE HYPERTENSION
B) A LOW CVP
C) NO DICROTIC NOTCH
D) NONE OF THE ABOVE

Q.24 MYOCARDIAL INFARCTION CAN CAUSE A CVP
A) TO ELEVATE ABOVE NORMAL
B) TO DECLINE BELOW NORMAL
C) TO REMAIN NORMAL
D) NONE OF THE ABOVE

Q.25: ACUTE PULMONARY EDEMA CAN CAUSE A CVP
A) TO ELEVATE ABOVE NORMAL
B) TO DECLINE BELOW NORMAL
C) TO REMAIN NORMAL
D) NONE OF THE ABOVE

Q.26: AN ERRONEOUSLY LOWCVP MAY CAUSED BY
A) THE TRANSDUCER ABOVE THE PHLEBOSTATIC AXIS
B) THE TRANSDUCER MID THE PHLEBOSTATIC AXIS
C) THE TRANSDUCER BELOW THE PHLEBOSTATIC AXIS
D) THE TRANSDUCER AT THE PHLEBOSTATIC AXIS

Q.27: ARTERIAL CATHETERS ARE ROUTINELY INSERTED INTO A
A) RADIAL ARTERY
B) SUBCLAVIAN ARTERY
C) POPLITEAL ARTERY
D) CAROTID ARTERY

Q.28: HYPOVOLEAMIA CAN CAUSE A
A) TACHYCARDIA
B) LOW CVP
C) HYPOTENSION
D) ALL THE ABOVE
35
Q.29: WHICH OF THE FOLLOWING SYSTEMIC BP IS NORMAL
A) > 100 mmHg NEONATE
B) > 200 mmHg INFANT
C) > 90 mmHg ADULT
D) NONE OF THE ABOVE

Q.30: A NORMAL CVP CAN BE
A) 6 TO 0 mmHg
B) 10 15 mmHg
C) 20 30 mmHg
D) NONE OF THE ABOVE





















SELF ASSESSMENT SCORE: ________/ 30


36
ANSWERS


1 D

16 B
2 D

17 D
3 D

18 D
4 D

19 D
5 C

20 C
6 D

21 B
7 D

22 D
8 D

23 D
9 D

24 A
10 A

25 A
11 C

26 A
12 D

27 A
13 D

28 D
14 B

29 C
15 D

30 D






37
REFERENCES

DAROVIC G. O. 1987. HEMODYNAMIC MONITORING. INVASIVE AND NON
INVASIVE CLINICAL APPLICATIONS. WB SAUNDERS
GANONG, W.F. 1983. REVIEWOF MEDICAL PHYSIOLOGY. (11
TH
ED.) LANGE
MEDICAL
GUYTON, AC, TEXTBOOK OF MEDICAL PHYSIOLOGY. SEVENTH EDITION;
W.B. SAUNDERS COMPANY, PHILADELPHIA, 1986
GUYTON, A.C. (1977) BASIC HUMAN PHYSIOLOGY: NORMAL FUNCTION AND
MECHANISMS OF DISEASE. SAUNDERS
MORTELL, M. 2004 UNPUBLISHED LECTURE NOTES
MORTELL, M2006 NGHA UNDERSTANDING HEMODYNAMIC MONITORING
WORKSHOP
SMITH J.J. 1990. CIRCULATORY PHYSIOLOGY. 3
RD
EDITION. WILLIAMS AND
WILKINS. SYDNEY
OH, T.E 1997; INTENSIVE CARE MANUAL, (4
TH
ED), BUTTERWORTH,
HEINEMANN