Ebook Critical care ultrasound: Part 2
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Ebook Critical care ultrasound: Part 2
SECÌ1U15 VIHemodynamicsHemodynamic Monitoring Considerations in the Intensive Care UnitDAVID STURGESS I DOUGLAS R. HAMILTON I ASHOT E. SARGSYAN I PHIL Ebook Critical care ultrasound: Part 2LIP LUMB I DIMITRIOS KARAKITSOS. . . the blood somehow flowed back again from the arteries into the veins and returned to the right ventricle of the heart. In consequence, I began privately to consider that it had a movement, as it were, in a circle ... by calculating the amount of blood transmitted Ebook Critical care ultrasound: Part 2 [at each heartbeat] and by making a count of the beats, let US convince ourselves that the whole amount of the blood mass goes through the heart fromEbook Critical care ultrasound: Part 2
the veins to the arteries and similarly makes the pulmonary transit. . ..William Harvey: De motu cordis. In The circulation of the blood and other wrSECÌ1U15 VIHemodynamicsHemodynamic Monitoring Considerations in the Intensive Care UnitDAVID STURGESS I DOUGLAS R. HAMILTON I ASHOT E. SARGSYAN I PHIL Ebook Critical care ultrasound: Part 2nly detection of cardiovascular insufficiency and diagnosis of the underlying pathophysiology. At the bedside, clinicians are faced with the challenge of translating concepts such as preload, contractility, and afterload into determinants of stroke volume and hence cardiac output. Ultrasound and ech Ebook Critical care ultrasound: Part 2ocardiography offer unique insight into ventricular filling and systolic function. In recent years there has been a general trend away from invasive hEbook Critical care ultrasound: Part 2
emodynamic monitoring This was initially motivated by published data suggesting an association between the pulmonary artery catheter (PAC) and excess SECÌ1U15 VIHemodynamicsHemodynamic Monitoring Considerations in the Intensive Care UnitDAVID STURGESS I DOUGLAS R. HAMILTON I ASHOT E. SARGSYAN I PHIL Ebook Critical care ultrasound: Part 2rtality.-' The PaC should not be regarded as obsoleteAs already discussed in this text, ultrasound IS proving useful in guiding safe and timely placement of many components of hemodynamic monitoring systems, including arterial, peripheral. and central venous access devices. Furthermore, because of i Ebook Critical care ultrasound: Part 2ts real-time nature, ultrasound, including echocardiography, offers the clinician a range of cardiovascular insights that are difficult or impossibleEbook Critical care ultrasound: Part 2
to derive with other technologies. Ultrasound can be applied to a wide range of patients and IS a safe, noninva-sive. and reliable imaging method.HemoSECÌ1U15 VIHemodynamicsHemodynamic Monitoring Considerations in the Intensive Care UnitDAVID STURGESS I DOUGLAS R. HAMILTON I ASHOT E. SARGSYAN I PHIL Ebook Critical care ultrasound: Part 2hniques available for estimating cardiac output, including nonultrasonic modalities. This broader topic is covered well in the literature- and is outlined only briefly here. Demonstrating an association between any monitoring modality and improvedoutcome IS challenging. Monitoring must be coupled wi Ebook Critical care ultrasound: Part 2th an effective change in therapy for a positive association to be observed. Clinical practice is characterized by the subtleties of interpretation, oEbook Critical care ultrasound: Part 2
ngoing review, and titration of therapy to response. This does not translate easily into large-scale, randomized, controlled trial designs.Clinicians SECÌ1U15 VIHemodynamicsHemodynamic Monitoring Considerations in the Intensive Care UnitDAVID STURGESS I DOUGLAS R. HAMILTON I ASHOT E. SARGSYAN I PHIL Ebook Critical care ultrasound: Part 2iliarity, availability of local expertise, cost (equipment and consumables), and applicability to a particular patient and the patient s status must also be considered. Monitoring techniques tend to not be mutually exclusive and may be combined or changed to achieve the desired effect. For instance, Ebook Critical care ultrasound: Part 2 initial hemodynamic evaluation with echocardiography may proceed to continuous monitoring, such as pulse waveform analysis.Any form of hemodynamic moEbook Critical care ultrasound: Part 2
nitoring (Table 36-1) should be viewed as an adjunct to the clinical examination and must be interpreted as an integration of all available data.3'5 TSECÌ1U15 VIHemodynamicsHemodynamic Monitoring Considerations in the Intensive Care UnitDAVID STURGESS I DOUGLAS R. HAMILTON I ASHOT E. SARGSYAN I PHIL Ebook Critical care ultrasound: Part 2 pressure, jugular venous pressure (or central venous or right atrial pressure [RAP] I. and electrocardiography should also be incorporated Other adjuncts to the interpretation of hemodynamic data might include Svo> Scvo>. lactate, blood gases, capnography, gastric tonometry, or other assessment of Ebook Critical care ultrasound: Part 2the microcirculation.Ultrasound indicator dilution is a novel application of ultrasound technology. Unlike transpulmonary thermodilution, which basesEbook Critical care ultrasound: Part 2
estimates of cardiac output on changes in blood temperature, ultrasound indicator dilution measures changes in ultrasound velocity. Normothermic isotoSECÌ1U15 VIHemodynamicsHemodynamic Monitoring Considerations in the Intensive Care UnitDAVID STURGESS I DOUGLAS R. HAMILTON I ASHOT E. SARGSYAN I PHIL Ebook Critical care ultrasound: Part 2(blood. 1560 to 1585; saline. 1533 m sec) allows the19436 Hemodynamic Monitoring ConsideratioiExamples of Cardiac Output Monitoring Techniques and DevicesTechniqueCommentExample of DeviceFlow probeSometimes used as a laboratory reference standard. Limited d in calDopplerapplicationElectromagnetic Fi Ebook Critical care ultrasound: Part 2ck method (OđRequires a pulmonary artery catheter and metabolic cart. OftenIndãccl I ide method (GOj)posed as Inn dinicil reference standard l>ut precEbook Critical care ultrasound: Part 2
onditions often rxjt met in critical wire Partial rebtcalhirig technique incxxfxirating a numlxs Ilf mathematicNICOPartial inbreathing techniqueasttirSECÌ1U15 VIHemodynamicsHemodynamic Monitoring Considerations in the Intensive Care UnitDAVID STURGESS I DOUGLAS R. HAMILTON I ASHOT E. SARGSYAN I PHIL Ebook Critical care ultrasound: Part 2r Piiirncxiary artery catheter (bolus or wariri/sernitxxiliriucxis)Transpulmonary indicator dilutionPtccoI her modilul ionVokrmeVicwI ilhium1 iix:oIndocyanine green Dye dilution Pulsed dye densitometry ultrasound indicator dilution (saline)Dm; indicator dilution curve is formulated frrxn changes mea Ebook Critical care ultrasound: Part 2suredCOslatusI sophageal Dopplerin ultrasound velocity (tilcxid, 1560 15B5; saline. 1533 m/sec)CardtoOTranscutaneous DopplerMay lx: applied to suprastEbook Critical care ultrasound: Part 2
ernal (aortic valve) and parasternal (pulmonic valve) windowsHnrnoSonic WAKte ĨO USCOMArterial pressure waveform analysisPtccoThoracic electrical broiSECÌ1U15 VIHemodynamicsHemodynamic Monitoring Considerations in the Intensive Care UnitDAVID STURGESS I DOUGLAS R. HAMILTON I ASHOT E. SARGSYAN I PHIL Ebook Critical care ultrasound: Part 2 dilution curve and calculation of cardiac output?SECÌ1U15 VIHemodynamicsHemodynamic Monitoring Considerations in the Intensive Care UnitDAVID STURGESS I DOUGLAS R. HAMILTON I ASHOT E. SARGSYAN I PHILGọi ngay
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