Download Fundamental Critical Care Support by Janice L. Zimmerman PDF

By Janice L. Zimmerman

The Society of severe Care drugs is the prime expert association devoted to making sure excellence and consistency within the perform of severe care medication.

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Indices of preload include CVP, PCWP, LVEDP, and LVEDV. Curve I represents a “normal” cardiac function curve whereby serial increases in preload generate progressive improvement in cardiac function to a point. Curve II represents cardiac failure. Curve III represents a hyperdynamic ventricle. In order to move from curve II to I to III, an inotrope can be administered. In order to move from left to right, from a point of relative excessive preload to a more “normal” ventricular filling pressure, a diuretic or vasodilator can be administered.

ARTERIAL CANNULATION Percutaneous arterial cannulation is most often performed for the purpose of continuous monitoring of blood pressure. Continuous beat-to-beat blood pressure monitoring is essential in patients with rapidly changing hemodynamic status and patients receiving rapidly acting cardiovascular agents. Under some circumstances, such as extreme obesity, arterial blood pressure monitoring may necessarily and appropriately take the place of noninvasive pressure monitoring. Arterial cannulation is also indicated when there is a need for frequent blood biochemical analyses, especially arterial blood gas analysis.

A large variety of catheters are available for venous access and the choice of catheter must be based on its intended purpose. CVCs are used for the infusion of vasoactive substances, intravascular volume replacement, total parenteral nutrition (TPN), hemodialysis, and hemodynamic monitoring. CVCs are routinely placed in many clinical settings; however, they are probably more frequent in operating rooms and ICUs. Large-bore singlelumen catheters are best suited for rapid infusion of fluid, whereas multi-lumen catheters are important when multiple infusions of a potentially incompatible nature must be administered simultaneously.

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