Anästhesie (Subject) / Intensivmedizin (Lesson)
There are 21 cards in this lesson
FMH
This lesson was created by annescheidecker.
This lesson is not released for learning.
- Cardiac Index: Berechnung Norm CI = HMV/KÖ = (SV x Hf)/KÖ Norm: 2.8-4.2 l/min/m2
- Schlagvolumen: Berechnung Norm SV=CO x 1000/HR CO=Cardiac output HR=Heart rate Norm: 50-110 ml (per beat)
- SVR: systemic vascular restistence SVR= (MAP-ZVD)x80/CO 900-1400 dynes.sec.cm-5 Systemic vascular resistance index (SVRI): 1760-2600 dyn.s/cm5/m2. The most important factor that determines the systemic vascular resistance (SVR) is the tone of the small arterioles. autoregulation. CO= Cardiac output
- PVR: pulmonary vascular resistence PVR = (MPAP-PCWP) x 80 / CO Norm: 20-120 dyne sec/cm5 (ca 1/10 des systemischen Widerstands) Approximately 50% of the PVR resides in the arteries and arterioles 30% in the alveolar capillaries 20% in the veins Dünnwandigkeit und Dehnbarkeit der Lungenarterien > Schwerkraft und Lage haben grösseren Einfluss als der Gefässtonus auf den Fluss PVR is increased by Vasoconstrictor drugs 5-HT and Histamine Hypoxie Hypercapnia Azidose and is lowered by Vasodilator drugs Prostacycline and Acetylcholine. Anaemia (reduces blood viscosity which decreases PVR)
- Druck rechter Vorhof 1-10 mmHg
- rechter Ventrikel 15-30/0-8 mmHg
- Drücke Pulmonalarterie Norm: 15-30/5-15 mmHg MPap: basal 24 mmHg, apikal 6 mmHg Primär PAH: Mehr an Vasokonstriktoren: Thromboxan, Endothelin Erhöhter Serotonin - und Zytokinspiegel Weniger Vasodilatatoren: NO, Prostazyklin Sek. PAH: COPD, Lungenfibrose, portale HT, Sichelzellanämie, Schlafapnoe, Thrombembolien, u.a.m Therapie: Caciumantagonisten, Prostazyklinderivate (Ilprost), Endothelinrezeptor-Antagonisten, PGE 5 Inhibitoren (Sildenafil) Bei Rechtsherzbelastung: Digitalis, Diuretika O2 Antikoagulation zur Thrombembolieprophylaxe
- Pulmonalarterieller Mitteldruck 10-20 mmHg
- pulmonalkapillärer Wedgedruck 5-15 mmHg
- Druck linker Vorhof 4-12 mmHg
- enddistolischer Druck linker Ventrikel 4-12 mmHg
- Systolischer Druck linker Ventrikel 90-140 mmHg
- linksventrikuläres enddiastolisches Volumen 140 ml
- Pulmonary capillary Wedge pressure > enddiastolic left ventricular pressure Mitralstenose Catheter tip in Zone 1 PEEP nach Mitralklappenersatz
- Hyponatriämie Hyponatraemia can be subdivided into those with large amounts of sodium in their urine and those with little urinary sodium (classically large sodium excretion is greater than 20 mmol/L). Hyponatraemia due to excessive urinary loss (hence high urinary sodium excretion) can result from diuretic use, Addison's disease or diabetes (due to an osmotic diuresis). Hyponatraemia due to sodium loss elsewhere is caused by burns, small bowel obstruction, diarrhoea, cystic fibrosis and heat exposure. Hyponatraemia can also be divided into the patient's hydration status: Euvolaemic - causes include hypothyroidism and the syndrome of inappropriate antidiuretic hormone secretion (SIADH) Hypovolaemic - causes include vomiting, diuretics and hypoadrenal states (for example, Addison's disease) Hypervolaemic - causes include liver cirrhosis, nephritic syndrome and congestive cardiac failure.
- Treatment of a metabolic alkalosis (saline responsive): Re-expand volume with normal saline ( primary therapy). Supplement with potassium to treat hypokalaemia (alkalosis associated with severe hypokalaemia will be resistant to volume resuscitation until K is repleted). H+ blockers or PPIs if vomiting/NG suction to prevent further losses in H+ ions. Discontinue diuretics. Acetazolamide if NS contraindicated due to CHF. (Monitor for hypokalaemia). HCl or NH4Cl in emergency. (HCl can cause haemolysis, NH4Cl should not be used in liver disease).
-
- Pulmonalarterieller Katheter Grösse: 5G bis 8G Länge: 110 cm Lumen: Abstände jeweils 10 cm von der Spitze ab. Thermistor: 3.7 cm entfernt von der Spitze Plazierung Low pressure waves are seen as the catheter enters the right atrium (mean of 3-8 mmHg). Entry of the catheter into the right ventricle displays tall pressure waves (15-25 mmHg systolic and 0-10 mmHg diastolic). Inflation of the balloon directs the catheter through the pulmonary valve into the pulmonary artery, results in the pressure waveform displaying higher diastolic pressures (10-20 mmHg), but similar systolic pressures to the right ventricle (15-25 mmHg). A dicrotic notch may be seen on the pulmonary artery waveform, which is caused by the closure of the pulmonary valve. Wedging of the catheter balloon in a branch of the pulmonary artery causes damping of the pressure waveform (pulmonary artery occlusion pressure or wedge pressure). The mean pressure measured during wedging is 4-12 mmHg, and this reflects the filling pressure in the left side of the heart.
- Nierenversagen, akut normal urine:plasma osmolality ratio is >2:1 serum urea nitrogen (Harnstoffstickstoff)/serum creatinine 12-20. acute renal failure due to a prerenal cause: fractional sodium excretion is less than 1% (ADH Erhöhung) urinary sodium concentration < 20 mmol/l. urine:plasma osmolality ratio >1:1.6. Serum urea : creatinine >100 serum urea nitrogen/serum creatinine >20 Urine osmolality is >500 Urine/serum creatinine is > 40 acute renal failure due to intrinsic renal disease fractional sodium excretion >2% urinary sodium concentrations >20 mmol/l. urine:plasma osmolality ratio <1:1. Serum urea : creatinine <40 (Krea abhängiger von GFR) serum urea nitrogen/serum creatinine 10-15 Urine osmolality < 350 Urine/serum creatinine < 20
- Hypothermie Hypothermia is defined as a core temperature less than 35°C, and is associated with: Hypopituitarism Hypothyroidism Spinal cord trauma, and Alcohol and drug overdose. In hypothermic patients the oxygen dissociation curve is shifted to the left. A metabolic acidosis is commonly seen in hypothermia, and is exacerbated by a reduction in hepatic clearance and renal excretion of hydrogen ions and lactic acid. Other complications include: Acute pancreatitis Hyperglycaemia Thrombocytopenia, and A coagulopathy. Passive rewarming is appropriate when the core temperature is above 33°C, but active measures are required when the temperature is lower. Hypotension may be seen as the core temperature rises, as hypovolaemia is revealed and will usually require fluid resuscitation.
- mixed venous oxygen saturation A mixed venous oxygen saturation (SvO2) >80% is considered high. It is caused by High oxygen delivery, for example, a high FiO2 and A decreased O2 demand, for example, anaesthesia, hypothermia and Decrease O2 tissue uptake (as in sepsis).
- Hyperkalzämie The effects of hypercalcaemia are due to the elevated ionised calcium and symptoms usually present when the level is above 3.5 mmol/l. Treatment is aimed at controlling the underlying disease, rehydrating the patient and lowering the calcium level. Normal saline re-expands the intravascular volume and decreases calcium reabsorption in the renal tubules. Biphosphonates Calcitonin Furosemide Corticosteroids Trisodium edetate (EDTA; Ethylendiamintetraessigsäure) Dialysis.