Tapesh Bansal
Pasas Hospital, IndiaPresentation Title:
Arterial pulse and tracings -Basic Hemodynamics
Abstract
Fundamental Equations:
• Cardiac Output = Stroke Volume × Heart Rate
• Blood Pressure = Cardiac Output × Systemic Vascular Resistance (SVR)
• Mean Arterial Pressure (MAP) = (1/3 × Systolic BP) + (2/3 × Diastolic BP)
• Pulse Pressure = Systolic BP - Diastolic BP
Ensuring Accurate Arterial Line Readings:
• Verify accuracy with a non-invasive blood pressure (NIBP) device, ensuring correct cuff size.
• Check for transducer positioning, zeroing, air bubbles, clots, or line kinks.
• Perform a flush test to assess damping and take corrective actions if necessary.
Arterial Waveform Analysis
• The waveform offers insights into:
o Stroke volume and left ventricular contractility (systolic upstroke).
o SVR and arterial compliance (diastolic runoff and dicrotic notch position).
o Pathophysiological changes in conditions like septic shock, hypovolemia, and cardiogenic shock.
Key Concepts in Waveform Interpretation:
1. Dicrotic Notch: Indicates interaction between forward and reflected waves; influenced by SVR changes.
2. Windkessel Effect: Aortic compliance ensures diastolic flow through elastic recoil.
3. Pulse Wave Amplification: Systolic pressure increases and diastolic pressure decreases from the aorta to peripheral arteries, while MAP remains stable.
Clinical Applications:
• Hemodynamic Monitoring: Assess cardiac contractility, SVR, and stroke volume in real-time.
• Shock States:
o Septic shock: Vertical upstroke and downward dicrotic notch.
o Hypovolemia: Narrower pulse pressure with increased contractility.
o Cardiogenic shock: Slanted and low-amplitude upstroke.
• Respiratory Variations: Indicative of fluid responsiveness, particularly in ventilated patients.
Advanced Techniques:
• Pulse Contour Analysis: Provides cardiac output estimates using pressure waveforms. Calibrated systems (e.g., PICO) and uncalibrated systems (e.g., VIGLIO) analyze waveform shapes and areas to determine hemodynamics.
The ensuing presentation emphasizes the importance of interpreting arterial traces in clinical settings, offering actionable insights without relying solely on advanced cardiac output monitors.
Biography
TBA
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